Get Voluntary Benefit Application - State Of Wyoming - Wyoming

Filling out the Voluntary Benefit Application for the State of Wyoming is an essential step for employees who wish to access various insurance benefits. This guide provides clear, step-by-step instructions to assist you in completing the application accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your employee information in the designated fields. Provide details such as your agency name and number, employee name, social security number, address, city, state, zip code, date of hire, date of birth, gender, and marital status.
3. Next, navigate to the coverage election section. Here, select the benefits you wish to enroll in. Review the options for vision, disability, long-term care, and short-term disability, indicating your choices for single coverage or family coverage.
4. After selecting your coverage, provide your earnings information. Specify your earnings per hour, per week, per month, or per year, along with the hours worked per week.
5. Review the terms related to eligibility and costs for the benefits selected. Make sure you understand the payment deductions based on your coverage choices.
6. In the signature section, affirm your choices by signing and dating the application. Ensure that you agree to the deductions from your wages for the coverage you selected.
7. If you choose to waive or decline any benefits, fill out the withdrawal or decline section, provide your name, and indicate which benefits you are waiving.
8. Verify that all sections are completed accurately. Incomplete forms may result in processing delays.
9. Once you have filled out the form completely, you can save your changes, download the form for your records, print it, or share it as necessary.

Start completing your Voluntary Benefit Application online today to ensure you secure the benefits you need.