Get Retiree Group Health Insurance Application - Wyoming

Filling out the retiree group health insurance application online is a vital step in ensuring that you receive the healthcare benefits you deserve as a retiree in Wyoming. This guide will walk you through the process of completing the application efficiently and accurately.

Follow the steps to complete your application online.

1. Click the ‘Get Form’ button to access the application form in your browser.
2. Begin by providing your personal information in the 'Retiree Information' section. Fill in your first and last name, middle initial, date of birth, gender, social security number, marital status, address, phone numbers, and agency name and number. This information is essential for identifying you as a retiree.
3. Indicate whether you are enrolling as a new retiree or changing your enrollment options. Select the type of coverage you wish to apply for: 'Retiree Only,' 'Retiree + Spouse,' 'Retiree + Child(ren),' or 'Family.'
4. Next, choose your deductible option from the available plans. Options include $750/$1,500, $1,500/$3,000 (High Deductible Health Plan), or $2,000/$4,000. Read the additional notes provided for Medicare eligibility and other specific information regarding your choice.
5. In the 'Enrollment Information' section, list the names and information of all family members you wish to insure. This includes adding their names, dates of birth, social security numbers, and indicating their relationship to you.
6. Review the sections regarding your acceptance of the group health plan and your responsibilities. You will need to sign and date this statement, affirming that the information provided is accurate and complete.
7. If you are declining or withdrawing from coverage, fill in details about the individuals and reasons for dropping coverage. Sign and date this section if applicable.
8. Once you have completed the application, review all provided information for accuracy. Make necessary corrections before finalizing the form.
9. You may now choose to save changes, download a copy of the completed application, print it for your records, or share it if needed.

Complete your application online today to ensure you receive your retirement health benefits.