Follow the steps to successfully complete the MI CS-1820.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the date when the application is sent in the designated section.
3. Provide the name and phone number of the human resource preparer overseeing your application.
4. Indicate the employee's identification number in the next field.
5. Enter the name of the qualified applicant, including last name, first name, and middle initial.
6. Fill out the hire date and the applicant’s address, including city, state, and zip code.
7. Provide the daytime phone number and the social security number of the employee or retiree.
8. List the department or agency, along with the unit code.
9. Indicate the name of the employee or retiree as it appears on official documents.
10. Answer whether 2 pay period prepay was used for the layoff.
11. Fill in the qualifying event date and the insurance end date.
12. Mark eligibility for the FMLA end date for dental and vision benefits.
13. Indicate whether the applicant is eligible for the LTD rider benefits.
14. Provide information regarding medicare eligibility and select the applicable qualifying event.
15. Choose which insurance coverage the applicant wishes to continue and mark the appropriate boxes.
16. For health coverage, indicate the current health carrier and select the duration for which coverage is needed.
17. Submit the completed form either by faxing it to the number provided or by mailing it to the designated address.

Complete your MI CS-1820 form online today to ensure your continued insurance coverage.