Get Request For Basic And/or Additional Insurance ... - Maine

Completing the REQUEST FOR BASIC AND/OR ADDITIONAL INSURANCE form is essential for obtaining the necessary insurance coverage you need. This guide provides a clear and supportive approach to successfully filling out the form online, ensuring you meet all required specifications.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Begin by entering your personal information. Fill in your name, social security number, and date of birth. Make sure to provide accurate details as these are critical for processing your request.
3. Next, input your mailing address, including street, city, state, and ZIP code. Clear communication of your address ensures that all correspondence regarding your insurance is sent to the correct location.
4. Indicate your date of hire and annual salary. This information is vital in determining your insurance eligibility and coverage amounts.
5. Select the type of coverage you are requesting by checking the appropriate box. Options include basic coverage and various supplemental amounts, such as one, two, or three times your basic coverage.
6. If you opt for dependent coverage, complete the respective sections for Dependent Plan A or Plan B. Carefully assess the risk associated with each category of dependents.
7. Read the note regarding the insurance policy limitations on dependent coverage carefully. This will help you ensure compliance with all conditions.
8. Once you have filled out all necessary sections, provide your signature and the date at the bottom of the form.
9. Finally, save your changes, and download or print a copy of the completed form for your records. Make sure to return the completed form to Survivor Services at the address provided at the top of the document.

Complete your REQUEST FOR BASIC AND/OR ADDITIONAL INSURANCE form online today to secure your coverage.