We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Multi-State Forms
  • Healthcomp Online

Get Healthcomp Online

FLEXIBLE BENEFITS ENROLLMENT/CHANGE FORM Mail to HealthComp Inc. P. O. Box 45018 Fresno CA 93718-5018 559 499-2450 or 800 442-7247 Fax 559 499-2045 This form is submitted for Marriage Divorce New Enrollment Name Change Address Change Termination Birth/Adoption Other EMPLOYEE INFORMATION Employer Employee s Telephone Employee s Name Social Security Employee s Address Date of Hire State Employment Status PT TEMP Date Eligible To Participate FT Zip .

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the Healthcomp Online online

Filling out the Healthcomp Online form is a straightforward process that allows users to manage their flexible benefits enrollment and changes effectively. This guide provides step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to complete your Healthcomp Online form.

  1. Press the ‘Get Form’ button to access the document and open it in your preferred editor.
  2. Fill in your employee information at the top section, including your employer, telephone number, name, social security number, address, date of hire, and employment status. Ensure all details are accurate.
  3. Indicate the type of change you are submitting by checking the appropriate box under the section titled 'This form is submitted for.' Options include marriage, divorce, new enrollment, and more.
  4. Under the premiums section, list the health benefits you wish to have deducted pre-tax per pay period. Specify the dollar amounts for medical, vision, disability, dental, life, and any other premiums.
  5. In the spending accounts section, select the benefits for which you want payroll deductions pre-tax. Fill in the dependent care and unreimbursed medical amounts for both annual and per pay period options.
  6. If applicable, provide details about any changes in family status, including terminating participation or changing pre-tax payroll deductions. Fill in the amounts you wish to change.
  7. Enter your employee's termination date and the effective date of change if you are submitting a termination of employment.
  8. Review the declarations section; affirm that the information provided is correct, and indicate whether you are requesting participation or declining the plan. Then, sign and date the form.
  9. After completing the form, you can save your changes, download the document for your records, print it, or share it as needed.

Complete your Healthcomp Online form today to efficiently manage your benefits.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

Comp & Benefits - Confederated Tribes of the Warm...
HealthComp – Health Coverage Customer Service 1-800-442-7247. Allegiance – Flexible...
Learn more
HealthComp online instructions - USC Employee...
Dear Health Plan Participant: HealthComp is excited to provide you with online account...
Learn more
Bravo Marine Heating System Bh 0133 Users Manual
Feb 2, 2015 — o Online through Emdeon or other office management software ... their...
Learn more

Related links form

New York City Landlords & Owners Questions & Answers About C-Store: A Column-oriented DBMS Instructions: Please Complete The Application And Send A Copy To ... Pet Application

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Healthcomp Online
Get form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232