Get Mi Employee Health Risk Assessment Questionnaire 2019-2025

This guide provides comprehensive instructions on how to accurately complete the MI Employee Health Risk Assessment Questionnaire online. It is important to follow each step carefully to ensure that your health insurance application is processed efficiently.

Follow the steps to complete the questionnaire successfully.

1. Click ‘Get Form’ button to access the questionnaire and open it in your preferred online editor.
2. Begin filling out the employer information in Section I. Provide the employer name, address, director of HR name, phone number, email address, and fax number as required.
3. In the employee information section, input your name, date of birth, gender, and social security number. Additionally, fill out your address, phone number, marital status, date of hire, occupation, and salary details.
4. In the application intentions section, indicate the coverage type you are applying for by selecting the appropriate boxes for you and your dependents. If waiving coverage for any, complete that section as well.
5. Proceed to Section II. Answer whether any of your dependents have other insurance by checking the 'Yes' or 'No' box, and provide the necessary details of the current insurance carrier.
6. Fill out Section III for beneficiary information, ensuring you provide the names, relationships, social security numbers, and dates of birth for both primary and contingent beneficiaries.
7. Section IV consists of various health questions. Answer all questions truthfully about any medical conditions, hospitalizations, or medications for you and your dependents.
8. After answering the health questions, verify that all parts of the form are completed accurately. Review your statements, ensuring that the provided information is true and complete.
9. Conclude by providing your signature, along with your spouse's if applicable, and date the form. This confirms your request for enrollment in the health plan.
10. Once the form is complete, save your changes, download, print, or share it as needed to finalize your submission.

Complete your MI Employee Health Risk Assessment Questionnaire online today to ensure your health coverage is active.