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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 .

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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.

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