Get Enrollment/waiver Form - Ka Hamilton & Associates

This guide provides comprehensive instructions on completing the Enrollment/Waiver Form for KA Hamilton & Associates. Whether you are enrolling for the first time or making changes to your coverage, following these steps will help ensure your submission is accurate and complete.

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

1. Press the ‘Get Form’ button to access the Enrollment/Waiver Form. This will open the document for you to start filling it out.
2. In Section A, select the Type of Program that best suits your needs. There are options for different plans, such as FFS—Indemnity or DHMO. Specify any additional details required.
3. Still in Section A, identify the Type of Activity. Here, indicate whether you are enrolling, canceling, or making a change to your coverage. Ensure you provide the effective date if required.
4. Move to Section B to fill in employer details. Provide the Employer Name and the Group Number, which should be a nine-digit number.
5. In Section C, enter your Employee Information clearly. Include your Identification Number (Social Security Number), Date of Birth, and full name (first name, middle initial, and last name). Fill in your home address along with city, state, and ZIP code.
6. Proceed to Section D for Dependent Information. If you are adding or cancelling dependents, list their details here, ensuring all information is accurate.
7. In Section E, indicate whether you or any dependents have other group dental coverage by marking 'Yes' or 'No.' If applicable, provide the policyholder's name, insurance company, policy number, and effective date.
8. After completing all sections, review the information for accuracy. Don’t forget to include your signature, contact number, and email address where indicated, along with the date of submission.
9. Finally, save your changes to the form. You can choose to download, print, or share the completed document as required.

Complete your Enrollment/Waiver Form online today to ensure your dental coverage needs are met.