Get Enrollment/change Form - Cornish

Filling out the Enrollment/Change Form - Cornish is a crucial step for users seeking to enroll or make changes to their dental coverage. This guide will provide you with step-by-step instructions to ensure a smooth and accurate completion of the form online.

Follow the steps to successfully complete the Enrollment/Change Form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Select the type of enrollment by checking the corresponding box for 'New', 'Change', 'Open Enrollment', 'COBRA', or 'Other'.
3. Enter your group number, employer or group name, sub-group details, and your personal information, including last name, first name, middle initial, hire date, effective date, social security number, birthdate, phone number, and address. Make sure to enter your city, state, and zip code accurately.
4. List all dependents to be covered by adding their details, including last names, first names, genders, birthdates, and any necessary designations for those over age, full-time students, or incapacitated. Use the 'Add' or 'Remove' options as needed.
5. If any of your dependents have other dental coverage, indicate this by checking 'Yes' or 'No'. If applicable, complete the section with the other insurance carrier's name, address, and effective date.
6. For COBRA enrollment, complete the relevant sections including the qualifying event details and effective date, alongside relationship to the subscriber.
7. Review your completed form for accuracy, ensuring that all required fields are filled out correctly.
8. Once you have filled out the form, you can save any changes, download a copy, print it out for your records, or share it with relevant parties.

Begin filling out the Enrollment/Change Form - Cornish online today for effective management of your dental coverage.