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  • 1 Send Enrollment Forms To This Contact - Opm

Get 1 Send Enrollment Forms To This Contact - Opm

N Name Enrollment Forms Contact Name Address City State 18 Humana Care Plan NATALIE HALL LOUISVILLE KY 101 E MAIN ST 9TH FL I Zip Code J Phone Number K Phone Number Work FAX 40201 (502)580-7427 2C PIEDMONT COMMUNITY HEALTHCARE (VIRGINIA) CHERYL F MIDKIFF 2255 LANGHORNE ROAD SUITE 2 LYNCHBURG VA 24501 (804)947-4463 x216 2U Aetna U.S. Healthcare MS. JOANNE DOTY 1425 UNION MEETING RD BLUE BELL PA 19422 (215)775-4340 2X Aetna U.S. Healthcare MS. JOANNE DOTY 1425 UNI.

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How to fill out the 1 Send Enrollment Forms To This Contact - Opm online

This guide provides clear and detailed instructions on how to properly complete the 1 Send Enrollment Forms To This Contact - Opm document online. Whether you are new to online forms or have experience, this step-by-step guide will assist you in ensuring all necessary information is filled out correctly.

Follow the steps to complete your enrollment forms effectively.

  1. Press the ‘Get Form’ button to download the enrollment form and open it in your preferred document editor.
  2. In the first section, fill out the 'Carrier Code.' This code corresponds to the specific health plan you are enrolling in. You can find this code listed next to the plan names.
  3. Next, provide the 'Plan Name.' This should match the plan associated with the carrier code you entered.
  4. In the 'Enrollment Forms Contact Name' field, enter the contact person's name for the enrollment forms. Ensure you spell their name correctly.
  5. Input the address of the contact person in the designated fields: 'Address,' 'City,' and 'State.' Make sure these are accurate and complete.
  6. Fill in the 'Zip Code' for the contact address. This should be a five-digit code.
  7. Next, provide the 'Phone Number.' If applicable, also enter the 'Work' and 'Fax' numbers.
  8. Repeat the above steps for any additional contacts you may need to include in the form, ensuring all fields are correctly filled out for each contact.
  9. After all information is filled out, review the complete form for any errors or omissions.
  10. Once confirmed, save the document, and you may choose to download, print, or share it according to your needs.

Complete your enrollment forms online to ensure your application is processed efficiently.

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Contact support

You can write to the Office of Personnel Management at OPM, P.O. Box 45, Boyers, PA 16017-0045, call OPM's Retirement Information Office at 1-888-767-6738, or send us email at retire@opm.gov.

Plan Enrollment Code allows Clients, who choose to retain responsibility for monitoring and determining participant eligibility, to offer a self-service, online enrollment experience for their employees.

As a new employee, you have 60 days from your date of appointment to make an election for the health benefits program. Your completed Health Benefits Election Form, SF-2809, must be submitted to your servicing Human Resources Office in a timely manner.

Enrollment codes are found on the front cover of each plan's brochure.

The FEP membership cards are identified by coverage codes 104, 105, and 106 for the Standard Option and 111, 112, and 113 for the Basic Option. FEP Blue Focus enrollment codes are 131, 132 and 133. Basic Option members must use preferred providers for all medical care (with some exceptions, such as emergency care).

A 3-digit code, reflecting the combination of the 2-character Plan Code and the 1-digit enrollment code. Enrollment codes reflect: Self Only (1,4), Self Plus One (3, 6), and/or Self and Family (2, 5).

The FEP membership cards are identified by coverage codes 104, 105, and 106 for the Standard Option and 111, 112, and 113 for the Basic Option. FEP Blue Focus enrollment codes are 131, 132 and 133.

Enrollment codes are found on the front cover of each plan's brochure.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232