Get Alliance Select Application - Employee And Retiree Benefits - State ... - Benefits Iowa

This guide provides comprehensive instructions for completing the Alliance Select Application for employee and retiree benefits in Iowa. Ensuring that the application is filled out correctly will facilitate a smoother process in obtaining health coverage benefits.

Follow the steps to accurately complete your application online.

1. Press the ‘Get Form’ button to access the application and open it for editing.
2. Begin filling in your personal information in the 'A. Name, Address and Coverage' section. Include your last and first name, complete residence address, employee status, and date employed.
3. Indicate your gender and provide your Social Security number, which is essential for the application.
4. Specify the type of benefits desired and provide your date of birth, as well as your Medicare ID number if applicable.
5. If applying for family coverage, list the names and required information of your spouse or domestic partner and all eligible children.
6. In section 'C. Event(s) or Reason(s) for Changing Contract', check the appropriate box that describes your situation such as marriage, divorce, or birth/adoption.
7. Complete section 'D. Medicare Coverage' for yourself and any dependents if relevant, providing Medicare ID numbers and effective dates.
8. In section 'E. Other Carrier Information', indicate if anyone in the application has other health coverage, and provide pertinent policy details.
9. Answer the questions in section 'F. Prior Coverage Information' regarding the health coverage history prior to the application.
10. Carefully review the 'G. Authorization and Certification' section and provide your signature and date to affirm your understanding of the terms.
11. If you are waiving health benefits, complete section 'H. Waiver of Enrollment' indicating the reason for the waiver.
12. Once all sections are completed, save your changes, then proceed to download, print, or share the application as needed.

Complete your Alliance Select application online today to ensure timely processing of your employee and retiree benefits.