Get Family Status Form

The Family Status Form is an essential document for individuals looking to report changes in their family situation that may affect their benefits. This guide is designed to walk you through each section of the form and provide clear instructions on how to complete it online.

Follow the steps to successfully complete the Family Status Form online.

1. Press the ‘Get Form’ button to obtain the Family Status Form and open it in your preferred editor.
2. Begin by filling in your personal information, including your last name, first name, middle initial, insurance ID, and social security number. Make sure all information is accurate and up-to-date.
3. Complete your address details, including street address, city, state, and zip code, as well as your date of birth and contact numbers for home, work, and cell phone.
4. Indicate the specific event that qualifies as a change in status by checking the corresponding box. Examples include birth, adoption, marriage, divorce, or employment changes.
5. Specify the date the change occurred and detail the coverage to be added or terminated for yourself and eligible dependents.
6. If applicable, provide details regarding tobacco use for yourself and your covered spouse, as this may affect coverage options.
7. Decide and indicate when the health coverage and any flexible benefits should take effect, as well as the requested termination date for any coverage you are ending.
8. Fill in the details for any spending accounts, indicating amounts per pay period and total for the fiscal year.
9. Affirm your understanding of the responsibilities associated with the family status change by reading the certifications and then signing the form electronically.
10. After reviewing all fields for completeness and accuracy, save your changes, download, print, or share the form as needed.

Complete your Family Status Form online today to ensure your benefits reflect your current family situation.