Get 2013 Senior Advantage Enrollment Form - Hi - Alseib

This guide provides a comprehensive overview of how to accurately complete the 2013 Senior Advantage Enrollment Form - HI - Alseib online. By following these step-by-step instructions, users can ensure a smooth and efficient enrollment process.

Follow the steps to successfully complete your enrollment form.

1. Press the ‘Get Form’ button to access the enrollment form and open it in your preferred editor.
2. Review the top section of the form where you will select your insurance coverage option. Choose only one option such as SEHIP Medical, BCBS Supplemental Coverage, or decline all coverage. If you are adding dental or vision coverage, ensure to attach the required forms (IB21 for dental, IB20 for vision).
3. Complete the subscriber information section by filling in your name, sex, social security number, effective date of coverage, date of birth, street address, city, state, ZIP code, home and work telephone numbers, and email address.
4. Provide required documentation for SEHIP and dental plans in this section and indicate your relationship to the employee, including options such as spouse, son, daughter, or grandchild.
5. Fill out the additional group health insurance coverage section, which requires you to indicate your Medicare coverage and primary group health insurance coverage. Answer whether there is a spousal carve-out and provide the name of your health insurance company and insurance policy numbers.
6. Read the affirmation and release section carefully. You must confirm that all information provided is accurate and complete. Sign and date the form in the designated area.
7. After completing all sections, review your entries for accuracy. Ensure all necessary attachments are included. You can then save your changes, download the form, print it, or share it as required.

Complete your documents online for a seamless enrollment experience.