Get Ecos Form Instructions Terms - Ferris State University - Ferris

Filling out the Enrollment Change of Status (ECOS) Form is a crucial step for managing your health coverage efficiently. This guide will walk you through each section of the form with clear instructions to ensure a smooth completion process.

Follow the steps to successfully complete the ECOS Form.

1. Click ‘Get Form’ button to obtain the ECOS Form and open it in your preferred editor.
2. Begin by entering your subscriber information. Fill in your Social Security Number or assigned contract number, group details, first and last name, and middle initial. Indicate your marital status and gender, and provide your date of birth.
3. Enter your home address, including street address, city, state, and zip code. Include your home and work phone numbers and email address if applicable.
4. List all persons you wish to enroll or terminate. Provide their names, dates of birth, gender, and check whether you want to add or delete them from coverage.
5. If you're enrolling family members under Blue Care Network, enter the primary care physician’s name, physician number, and location for each member.
6. Complete the section on other health coverage, indicating whether you, your spouse, or any dependents maintain other health coverage. If yes, provide required details.
7. Indicate if you, your spouse, or dependents are enrolled in Medicare. If applicable, attach a copy of the Medicare card(s).
8. In the signature section, sign the form, indicate the date of signing, and make any necessary remarks.
9. For internal group use, fill out the necessary group details, coverage type, and additional notes as required.
10. Once all sections are completed, review the form for accuracy. You can save any changes, download, print, or share the form as needed.

Complete your enrollment and change of status forms online to maintain your health coverage seamlessly.