Get Employee Enrollment/change Form - Cheyney University Of ...

Filling out the Employee Enrollment/change Form is an essential task for employees at Cheyney University. This guide provides clear and detailed instructions on how to accurately complete this form online, ensuring that all necessary information is submitted efficiently.

Follow the steps to complete your form online

1. Click the ‘Get Form’ button to access the Employee Enrollment/change Form in your web browser.
2. Complete the transaction section by selecting whether you are enrolling, adding or removing dependents, changing plans, or transferring agencies. Be sure to indicate your reason in the remarks section when required.
3. Provide your personal details in the employee data section. Fill in your full name, social security number, address, contact numbers, and marital status.
4. Choose your medical plan option from the available selections (e.g., HMO, PPO, POS). If selecting an HMO or POS option, indicate your primary care physician.
5. Skip to the dental plan option and select your preferred plan, if applicable. Ensure to provide the primary dental office information if you choose a specific dental plan.
6. Fill in any necessary demographic data. This includes providing your date of birth, sex, and any additional details about your marital status and family coverage.
7. Input dependent data if applicable. List eligible dependents, including their names, social security numbers, and birth dates. Indicate if they are being added or removed from your coverage.
8. Review the remarks section and fill in any additional comments or explanations required for coverage changes or dependents.
9. Read and acknowledge the authorization and signature section. This confirms your understanding of the agreement and your consent to the information provided.
10. Sign and date the form. Once you have completed all sections accurately, save your changes, download a copy for your records, print it if necessary, or share it as required.

Start completing your Employee Enrollment/change Form online today!