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Get Complete This Form Only If Changing Your Benefits
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How to fill out the Complete This Form Only If Changing Your Benefits online
Filling out the benefit choice election form is an essential step for individuals looking to adjust their benefits. This guide provides clear instructions to help you navigate the process of completing the form online, ensuring that your changes are submitted accurately and efficiently.
Follow the steps to correctly fill out your benefit choice election form online.
- Press the ‘Get Form’ button to access the benefit choice election form directly. This will open the necessary document for you to fill out.
- In Section A, enter your personal information including your last name, first name, Social Security number, and phone numbers for home and work. Ensure all fields are completed as this information is required.
- Move to Section B, where you will select whether to opt out of or opt into health, dental, vision, and prescription coverage. Mark the appropriate box and review the instructions carefully if you choose to opt out.
- Proceed to Section C for health plan elections. Select either the Quality Care Health Plan or Managed Care Plan. If opting for the Managed Care Plan, fill in the provider identifier and carrier code, ensuring correctness in your entries.
- Continue to Section D to decide on your dental plan option. Indicate whether you choose to participate in or opt out of the dental plan accordingly.
- In Section E, alter your optional life insurance coverage if necessary. Select the desired increments of coverage, including any AD&D options, based on your needs.
- Finally, fill out Section F regarding dependent information. Add or drop dependents for health and dental coverage as applicable, ensuring that you provide the required documentation as specified.
- Once all sections are completed, review your entries for accuracy. Save your changes, and you can then choose to download, print, or share the completed form with your Group Insurance Representative.
Complete your benefit choice election form online today to ensure your coverage changes are submitted on time.
If you miss your employer's open enrollment deadline, you could lose coverage for you and your loved ones, and you could be subject to a fine imposed by the Affordable Care Act (ACA). Missing this deadline also means that you could be unable to make changes or enroll in benefits until the next open enrollment period.
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