Get Choice Exception Review Request - Rogers Benefit Group

This guide will assist you in completing the Choice Exception Review Request for Rogers Benefit Group. It provides a detailed overview of each section of the form, ensuring you fill it out accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the group name and group number fields, ensuring that you fill out all required fields marked with an asterisk.
3. Enter the contact details including phone number, fax number, and email address in the designated fields.
4. List the names of the employees for whom the exception is being requested in the designated area.
5. Indicate the type of exception request by selecting one of the options provided: Loss of Coverage, Addition of an Employee, Gaining or Becoming a Dependent, Plan Correction, Correction of Employee Date of Hire, or Termination of an Employee.
6. Attach any applicable supporting documentation based on the type of exception you are requesting.
7. Provide a brief explanation for why the request was not submitted within the policy guidelines, ensuring clarity and conciseness.
8. Print the authorized contact's name in the designated section and ensure they sign and date the form.
9. Once all sections are filled out, review the form for accuracy. You can then save the changes, download, print, or share the form as needed.

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