Get Employee Enrollment / Waiver Eew-09 - Confidential - Rec ...

Filling out the EMPLOYEE ENROLLMENT / WAIVER EEW-09 form online is a crucial step for users to secure their health benefits. This guide provides clear instructions on how to complete each section of the form effectively, ensuring a smooth enrollment process.

Follow the steps to complete the EMPLOYEE ENROLLMENT / WAIVER form.

1. Press the 'Get Form' button to access the document and open it in your preferred editor.
2. Begin with Section 1: Group / Employer Information. Fill in your employer's details including group number, subgroup number, coverage effective date, and department number. Ensure all information is accurate as this section is mandatory for processing the form.
3. Indicate whether you are enrolling for the first time by checking the box for New Enrollment, and select the applicable qualifying event from the list provided. Fill this out only if it pertains to your situation.
4. Next, move on to Section 2: Employee/Member Information. Here, you must complete all fields including your name, date of birth, social security number, and contact information. Be sure to select your desired medical, dental, and vision options and indicate whether you have had continuous health coverage for the past 12 months.
5. Section 3 requires your acknowledgment. Read the statements carefully and sign where indicated to acknowledge your understanding of the coverage being applied for. Make sure to include the date of your signature and your phone number.
6. In Section 4: Dependent Information, provide complete information for any family members you wish to cover. This includes their names, social security numbers, dates of birth, and whether they have had continuous health coverage.
7. Proceed to Section 5: Ancillary Insurance Information. Select the applicable ancillary coverages such as life insurance and short-term disability. Fill in corresponding amounts if necessary.
8. If you are choosing to waive coverage, you will need to complete Section 6. Indicate which insurances you are declining and provide reasons for your decision. Ensure you sign and date this section as well.
9. Once all sections are completed, review the entire form for accuracy. Save your changes, and you will have the option to download, print, or share the form as needed.

Get started on completing your EMPLOYEE ENROLLMENT / WAIVER form online today!