Get Request For Employee Change Employer: Group #: Soc

This guide provides clear instructions on how to accurately complete the REQUEST FOR EMPLOYEE CHANGE form online. Whether you need to add dependents, change coverage, or update personal details, the following steps will assist you in navigating the form efficiently.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the REQUEST FOR EMPLOYEE CHANGE form and open it for editing.
2. Begin by filling in the employer's name, group number, and your social security number.
3. Enter your name in the designated field, providing your full name as it appears on official documents.
4. Indicate the desired changes to your health coverage by checking the appropriate box. Specify any dependents you wish to add, including their names, social security numbers, sex, date of birth, and relationship to you.
5. State your reason for adding dependents from the provided options, such as marriage, adoption, or birth, including the date of the change.
6. If you need to decrease or terminate coverage for any dependents, list their names and details similarly, along with the effective date of the change.
7. If you wish to cancel coverage, provide the reason and date in the specified fields.
8. To change the life insurance beneficiary, fill in the name of the new beneficiary.
9. If you intend to change the life insurance amount, specify the new amount in the appropriate field.
10. If there is a need to change your name, provide the new name in the corresponding section.
11. For any other changes, such as division or address updates, explain the changes in detail.
12. Make sure to sign and date the form, and ensure the company representative also signs and dates it where required.
13. Once all changes are made, save the completed form, and consider downloading, printing, or sharing it as necessary.

Complete your document online today for a smoother employee change process.