Get 2006 Open Enrollment Election Form - Yale University - Yale

Filling out the 2006 Open Enrollment Election Form for Yale University is an important step in selecting your benefits. This comprehensive guide will walk you through each section of the form to ensure you provide accurate and complete information.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Begin by providing your department information and date of hire. Clearly indicate your employment category as C+T Employee or S+M Employee.
3. Select your enrollment status by checking the appropriate box for new enrollment, cancellation, or change in medical and/or dental coverage.
4. Fill out your personal details including last name, first name, home address, city, state, zip code, and contact numbers. Ensure all fields are printed clearly.
5. Indicate your marital status by checking the correct box for single, married, or other.
6. Complete the medical and dental selections section for yourself and each covered dependent, including first names, last names, gender, birth dates, and selections by checking the boxes for your chosen plans.
7. Review the dependent eligibility requirements for medical and dental benefits and provide the name of the school attended by any dependents over age 19.
8. Disclose any other medical or dental coverage by answering the relevant questions and providing the names of the insurance companies and subscribers, if applicable.
9. Read and understand the authorization statements regarding the deduction of premiums and the accuracy of your information before signing and dating the form.
10. Save your changes once completed, and proceed to download, print, or share the form as needed.

Please ensure that you complete your enrollment documents online to secure your benefits.