Get Employer Application For Retiree Insurance Premium Remittance

This guide provides step-by-step instructions for filling out the Employer Application For Retiree Insurance Premium Remittance form online. It is designed to help users understand each section of the form clearly and easily, ensuring a smooth submission process.

Follow the steps to complete your application effectively.

1. Select the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Fill in Section I, which requires the employer name, date, mailing address, contact name, and phone number. Ensure that all required information is complete and accurate.
3. Indicate the name of the entity to whom the check should be made payable. This should reflect the proper title or organization.
4. Specify the requested effective date for insurance premium remittance. It is important that this date allows for processing prior to its effectiveness.
5. Move to Section II and identify the relevant coverage options using the monthly rates listed. Clearly mark whether you are selecting coverage for one person, two persons, or a family.
6. For any additional coverage options, mention the appropriate terms or names for each listed under 'Other'.
7. Once all sections are completed, review the form to ensure accuracy and completeness.
8. Save your changes, and prepare to download, print, or share the finished form as needed.

Complete your documents online today to ensure timely processing.