Get Enrollment/change Form - Baptist Health Plan

Filling out the Enrollment/Change Form for Baptist Health Plan online is an essential step for users seeking to enroll, change, or terminate their health coverage. This guide will provide you with clear directions on how to complete the form efficiently and accurately.

Follow the steps to complete the Enrollment/Change Form successfully.

1. Press the ‘Get Form’ button to access the Enrollment/Change Form and open it in your preferred editor.
2. Begin by filling in the Employer section. This includes mandatory fields such as Group Number, Company Name, and Hire Date. Make sure to include all necessary details to avoid processing delays.
3. Complete the Enrollee Information section. This involves providing your Last Name, First Name, Date of Birth, and other personal details such as your mailing address, phone numbers, and email address.
4. If applicable, select the appropriate Plan Option and indicate any Riders being included. This is crucial for ensuring you receive the correct level of health coverage.
5. Specify your Marital Status and indicate any dependents you wish to enroll, change, or terminate under coverage. Ensure to provide accurate information for dependents, including their Full Names, Dates of Birth, and Gender.
6. In the Other Health Coverage section, disclose any additional insurance you or your dependents may have. Please list family members who will be covered and provide necessary details like the Insurance Company Name and Policy Number.
7. Review and understand the Terms and Conditions. You must acknowledge your ability to report changes in your status and agree to the authorization terms provided.
8. Finally, sign and date the form, confirming all information is accurate and complete. Once finished, you can save your changes, download, print, or share the form as required.

Complete your Enrollment/Change Form online today to ensure your health coverage is properly set up.