Get Avmed Mp-5937 2014-2025

This guide provides a comprehensive overview of how to accurately complete the AvMed MP-5937 Employee Enrollment Form online. By following these steps, users can ensure that their healthcare coverage is properly established.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to access the AvMed MP-5937 and open it in your preferred online editor.
2. Select the coverage type by marking your desired choice, such as Employee Only or Family, and specify the plan option (e.g., HMO, Empower).
3. Input the employer information which includes the employer's name and group/division number.
4. Indicate your employment status by selecting Active or Retired, and provide the date of hire and employee effective date of coverage.
5. Fill in your personal details, including last name, first name, middle initial, address, social security number, birth date, gender, contact numbers, and email address.
6. If applicable, choose your Primary Care Physician (PCP) and enter their name and ID number.
7. Complete the dependent information section for any eligible dependents. Ensure to specify the relationship and provide necessary details as required.
8. Review and answer additional questions regarding tobacco use, Medicare coverage, and your spouse's employment and coverage status.
9. Sign and date the certification and authorization section, confirming the accuracy of the information provided.
10. After verifying all information, proceed to save changes, download, print, or share the completed form as necessary.

Complete your AvMed MP-5937 form online today to ensure your healthcare coverage.