Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to obtain the form and access it in the editor.
2. Begin by filling in your Participant (Subscriber) Information. Enter your Subscriber ID or Social Security Number, followed by your name as shown on your identification card, including your first name, middle initial, and last name.
3. Specify the effective date of these changes by filling in the month, day, and year when the changes will take effect.
4. If you are changing your name, check the appropriate box and provide your new name details, including first name, middle initial, last name, and any suffix as needed.
5. For address changes, indicate this by checking the relevant box and entering your new street address or PO Box, city, state, and zip code (including +4 if relevant).
6. If changing phone numbers or email addresses, check the corresponding boxes and enter your new work phone, personal phone, and new email address.
7. If you are updating your date of birth or gender, fill in the new details as required, ensuring to check the appropriate gender option.
8. For dependents, check the box to change their personal data, and provide the required information, including their first name, middle initial, last name, suffix, date of birth, and Social Security Number.
9. Finally, sign the form, date it, and ensure it is legible. Consider including documentation if necessary, particularly for Social Security Number changes.
10. Return the completed form to your employer’s benefits administrator. You can submit the authorized form via email, fax, or mail as per the provided contact information.

Take the next step to ensure your information is current by completing The Local Choice Personal Data Change Form online today.