Get 2021 Option Period Enrollment/change Form For Cobra Medicare ...

This guide will assist individuals in successfully completing the 2021 Option Period Enrollment/Change Form for COBRA Medicare online. Following this step-by-step approach will ensure that all necessary information is accurately provided and submitted in a timely manner.

Follow the steps to complete your form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering your personal information in the 'Member Information' section. Carefully fill in your name, Member ID or Social Security Number (SSN), mailing address, phone number, and email address. Ensure that all information is correct to avoid processing delays.
3. Review the section regarding changes to your health plan. Select whether you are making no changes, adding, changing, or dropping your health plan. If you are adding or changing plans, be sure to check the eligibility of your dependents as they must share the same plan.
4. Choose your desired health plan from the options provided. You may select either a Medicare plan or a Pre-Medicare plan based on your dependents’ eligibility. Be sure to review any additional enrollment applications required for certain plans.
5. In the 'Dental Plan' section, indicate if there are any changes. Choose to add or change your dental plan as necessary, and select from the listed options.
6. Proceed to the 'Vision Plan' section. Similar to the previous sections, indicate whether you are dropping, adding, or making no change to your vision plan.
7. Fill out the 'Dependent Changes' section, including any spouses or children's information. Indicate whether you are adding or dropping coverage for health, dental, and vision as needed.
8. Sign and date the form in the 'Certification Signature' section. It is important to sign this form to validate it. If you or your dependents are changing plans, ensure you complete any additional required applications.
9. Once you have filled out the form, review all provided information for accuracy. After verifying everything is correct, save your changes and consider downloading or printing the form for your records. Ensure the form is submitted by mailing it to the provided address before the deadline.

Take action today by completing your documents online to ensure timely processing.