Get Enter Employee Id Number - Kdheks

This guide provides clear and supportive instructions on how to complete the Enter Employee ID Number - Kdheks form online. By following these steps, users can efficiently provide the necessary information required for enrollment in the State Employee Health Plan.

Follow the steps to successfully fill out the form online

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the effective date of coverage in the designated field. This is the date when your health coverage begins.
3. Input your Employee ID number accurately in the specified field. This unique identifier is necessary for your enrollment.
4. Provide the name of the employee in the appropriate section. Ensure it matches the name that appears in official records.
5. Fill in the current address of the employee. An email address is optional but recommended for communication purposes.
6. Enter the current employee contact telephone number to ensure effective communication.
7. Input the social security number of the employee in the designated field. This is a critical piece of information for identity verification.
8. Select the gender of the employee as required by the form.
9. Fill in the employee’s date of birth accurately.
10. Select your tobacco use choice — ‘yes,’ ‘no,’ or choose not to disclose this information.
11. Indicate your willingness to enroll in the tobacco cessation program by selecting ‘Yes’ or ‘No.’
12. Provide the date of hire or qualifying event that has prompted this enrollment.
13. Indicate the type of action or use the narrative space to explain any additional circumstances relevant to your enrollment.
14. If applicable, enter the date the employee was hired in a benefits-eligible position.
15. If applicable, enter the date the employee was hired in a non-benefits-eligible position.
16. For non-state employer group employees, check the applicable salary tier that pertains to your position.
17. Indicate your choice for the payment of premiums, choosing either before tax or after tax.
18. Check the appropriate box to indicate if the employee is currently enrolled in the health plan as a dependent.
19. Select your medical insurance provider for the plan year by checking the corresponding box.
20. Choose your medical and prescription drug coverage level by checking the relevant box.
21. Select the dental coverage level choice by checking the applicable box; remember that dental coverage is automatic with the medical plan.
22. If applicable, check the vision coverage box to indicate your choice for vision coverage.
23. If applicable, select the vision coverage level option by checking the relevant box.
24. If adding dependents, enter the dependent relationship code in the designated space.
25. Provide the name of the dependent if applicable.
26. If applicable, enter the dependent’s social security number.
27. Input the gender of the dependent if required.
28. Fill in the dependent’s date of birth in the appropriate section.
29. Indicate if the dependent’s address is the same as the employee's or different. If different, provide the new address.
30. Enter the name of the Medicare eligible participant if applicable.
31. Input the effective date for Medicare Part A (Hospital) as required.
32. Provide the effective date for Medicare Part B (Medical).
33. Enter the Medicare claim number in the specified field.
34. Sign the document where indicated to confirm that the information provided is accurate.
35. Fill in the personnel officer or human resource representative information as necessary.
36. Once all sections of the form are completed, save any changes, and then decide whether to download, print, or share the form as needed.

Complete your enrollment forms online to ensure timely processing and coverage.