Get Oh Erc Employer/mco Open Enrollment Form 2014-2025

Completing the OH ERC Employer/MCO Open Enrollment Form online is a straightforward process designed to ensure that employers can select the best medical care organization (MCO) for their specific needs. This guide will provide you with clear, step-by-step instructions to successfully navigate the form.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the full form and open it for editing.
2. Begin by filling out the policy number. This is a unique identifier assigned to your business. Ensure you enter it accurately in the designated space.
3. Enter your business name in the next field. If your business operates under a different name, provide that information in the DBA (Doing Business As) field.
4. Input the contact person's full name, including their first, middle, and last names.
5. Select the CareWorks MCO that you have chosen by writing its name in the appropriate section.
6. Complete the address fields, ensuring you include street address, city, state, and zip code.
7. Provide a contact phone number, including area code, for follow-up communication.
8. Indicate the counties in which your business operates to help determine the geographic service area.
9. Specify the total number of employees in your organization for accurate demographic reporting.
10. Include an email address for any correspondence regarding the enrollment process.
11. Sign the form as the employer, ensuring that your signature is clear and legible. Also, fill in the date and your title within the organization.
12. After completing all fields, save the changes to the form, and consider downloading it for your records. You may also choose to print and fax it to CareWorks at 1-888-358-5319 before the deadline.

Complete your OH ERC Employer/MCO Open Enrollment Form online today to ensure your business's needs are met.