Follow the steps to successfully complete the application form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the group employee application section by filling in your last name, first name, middle initial, date of birth, sex, and social security number. Ensure that all details are accurate.
3. For section 1, policy eligibility, check all applicable boxes that indicate your eligibility, along with the date of the qualifying life event. Provide necessary documentation if the application is submitted outside the open enrollment period.
4. In section 2, indicate the coverage desired by selecting one of the options: employee only, employee and spouse, employee and children, or employee, spouse, and children. List the relationship of dependent children as natural, step, or adopted.
5. In section 3, select the appropriate marital status: single (including widowed or divorced) or married (including separated).
6. Provide contact information in section 4 by filling in your street address, city, state, zip code, primary phone number, work phone number, and email address.
7. In section 5, confirm your employment status by noting your job title, work classification (hourly, salaried, or other), and whether you are a current, active employee.
8. Complete section 6 by providing current and previous vision insurance information. Include details for each covered family member and indicate if any do not reside in your household.
9. For section 7, if applicable, provide any change requests along with the corresponding reasons. Include necessary changes to dependent status as required.
10. In section 8, read the authorization and signatures, fill in your printed name, signature, and the date. Ensure that the employer/group representative also signs and dates if required.
11. Review all filled sections for accuracy. You can then save the completed changes, download, print, or share the form as needed.

Complete your documents online with ease and ensure all necessary information is provided.