Get 333 Me&ps Form Rev400

Filling out the 333 ME&PS Form Rev400 online is a straightforward process that ensures you provide all necessary information for your health plan enrollment. This guide will walk you through each section of the form, helping you complete it accurately and efficiently.

Follow the steps to complete the 333 ME&PS Form Rev400 online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by filling out the employer section. Include details such as the group number, contract specific package (CSP), billing group (BG), date of full-time employment, and employer signature. Ensure all entries are accurate, as incomplete forms will be returned.
3. Proceed to the employee section. Record your legal name, date of birth, social security number, and marital status. Select your primary care physician and provide information on any other coverage you or your spouse may have.
4. Complete the dependent information section if applicable. For each eligible child, provide their name, birth date, social security number, and specify if any dependents are disabled.
5. Review the attestation section carefully. Sign and date the form in the appropriate boxes: Box A for HMO plans or both Box A and Box B for Freedom Plan options.
6. Once all sections are completed, save your changes. You may then download the form, print it, or share it as required.

Start filling out the 333 ME&PS Form Rev400 online to ensure your health coverage today.