Get Health Insurance Application (pdf) - University Of Wisconsin Hospital ... - Uwhealth

This guide provides step-by-step instructions for filling out the Health Insurance Application for the University of Wisconsin Hospital. By following these instructions, you can ensure that you accurately complete the application and submit it for processing.

Follow the steps to successfully complete your health insurance application.

1. Press the ‘Get Form’ button to obtain the application form and open it in your preferred editor.
2. Begin with Section 1: Applicant Information. Enter your full name, including any previous name, your Social Security Number, home address, and phone numbers clearly. If you are not enrolling, proceed to Section 7.
3. Indicate your marital or domestic partnership status by checking the appropriate box, and if applicable, provide the date of that status. List your spouse or domestic partner's details if you are married or in a partnership.
4. Select your eligibility status by checking the designated box that corresponds to your current employment situation.
5. For initial enrollment, indicate whether you want your coverage to start immediately or at a later date, and check the box for any changes during the annual enrollment period.
6. Specify the desired coverage level by checking either 'single' or 'family'.
7. Select the health plan you wish to enroll in for your health insurance.
8. In Section 2, indicate the reason for your application by checking the relevant boxes in subsections A and B, and follow the instructions for adding or deleting dependents if needed.
9. Fill out Section 3 with the enrollment information for yourself and any dependents, ensuring to provide correct SSNs and relationship codes.
10. Complete Section 4 by answering the additional information questions, and proceed to Section 5 to include details regarding Medicare coverage for yourself or your dependents.
11. In Section 6, provide information about any other health coverages that you or your dependents have.
12. Lastly, in Section 7, read the terms and conditions carefully. Indicate your agreement by signing and dating the application. Submit the form as instructed, making sure to keep a copy for your records.

Complete your health insurance application online today!