Get Group Long Term Care Enrollment Form University Of Nebraska - Nebraska

This guide provides step-by-step instructions for completing the Group Long Term Care Enrollment Form for the University of Nebraska. Follow this user-friendly process to ensure you accurately fill out the necessary information online.

Follow the steps to complete the enrollment form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section I, enter your employee information. Fill in your full name, social security number, date of birth, and sex. Provide your home address, daytime and evening phone numbers, city, state, and zip code. Include your employee personnel number and date of hire. Select your payroll frequency — either bi-weekly or monthly. Choose one administrative unit from the provided options.
3. Proceed to Section II. Here, select your daily benefit amount from the available options ($100, $150, or $200). Next, choose your lifetime maximum amount (3-year or 5-year). Indicate your inflation protection option by selecting either the guaranteed benefit increase option or the lifetime automatic benefit increase option. If applicable, select any combination of additional options such as the benefit account, return of premium at death, or caregiver benefit.
4. If you decide to reject inflation protection, confirm this by signing the corresponding statement in Section II and date your signature.
5. In Section III, verify the accuracy of your information and sign the eligibility and authorization statement. By signing, you agree to the terms of your selected coverage. Make sure to date your signature.
6. After completing all sections, review your entries for accuracy. You can then save changes, download, print, or share the form as required.

Complete your enrollment form online today to ensure you have the coverage you need.