Follow the steps to complete your form online.

1. Click ‘Get Form’ button to begin the process of downloading the form for online completion.
2. In the first section, 'Your personal information,' provide details such as your full name, Social Security number, former campus/lab location, and retirement system coverage. Ensure accuracy in providing your contact information including home and mailing addresses.
3. In the 'Action Requested' section, select the plan you wish to enroll in or make changes to. Be sure to follow any additional instructions related to documentation that may be required.
4. For the 'Your medical, dental, legal plan' section, indicate whether you wish to enroll, cancel, or suspend coverage for each applicable plan. Ensure you check the appropriate boxes for your selections.
5. Complete the 'Family member information' section by listing eligible family members and their relationship codes. Pay attention to the requirements for tax dependency and eligibility.
6. In the 'Signature' section, provide your signature, date, and daytime phone number. Remember that electronic signatures are accepted.
7. Review all the information provided to confirm its accuracy. Once you are satisfied, save your changes, and choose to download, print, or share the completed form as necessary.

Complete your documents online easily and efficiently!