Get Group Accounts Miscellaneous Change Form

Filling out the Group Accounts Miscellaneous Change Form online is a straightforward process that helps you manage important changes regarding your group account. This guide will provide you with step-by-step instructions to fill out the form efficiently and accurately.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to access the Group Accounts Miscellaneous Change Form and open it in your online document editor.
2. Begin with Section 1 by entering your group number and, if applicable, your health/life subscriber number. Fill in the primary insured's last name, first name, middle name, and home address. Also, provide your home, work, and cell telephone numbers along with your email address.
3. In Section 2, check the applicable box for the reason for the change, such as changing your name or adding or canceling coverage. Be sure to input the effective date for these changes.
4. Proceed to Section 3, where you will need to list all dependents being added or dropped. Refer to the guidelines regarding who qualifies as a dependent, and fill in each dependent's full name, date of birth, social security number, and address if different from yours.
5. If you are adding an over-age dependent, complete Section 4 by providing the name of the dependent and their nature of disability. Specify if the disability is permanent or temporary.
6. Move to Section 5 to answer health-related questions. Respond honestly to queries about prescription medications, previous insurance coverage issues, and any significant health concerns for each person listed on the form.
7. Once completed, review all sections for accuracy. You may save changes, download, print, or share the form as needed.

Complete your Group Accounts Miscellaneous Change Form online today to ensure your information is up to date.