Get Employee Eligibility Status Verification Form

Filling out the Employee Eligibility Status Verification Form online is a straightforward process that ensures you accurately report your employees' eligibility for benefits. This guide will provide you with clear instructions to navigate each section of the form with confidence.

Follow the steps to successfully complete the form online.

1. Locate and click the 'Get Form' button to access the document and open it in your online editor.
2. In the first section, provide the name of the individual confirming the employee status, such as an owner, partner, or officer. Make sure to carefully enter their full name.
3. Next, fill in the company name that the confirmation is regarding. This is crucial as it identifies the entity that the employee status applies to.
4. In the statement confirming the eligibility of employees, indicate that the people listed are full-time employees eligible for the benefit plan, ensuring accuracy throughout.
5. You are required to acknowledge that BCBSGA/BCBSHP may audit this information. Review this statement carefully to understand the implications.
6. Below the confirmation statement, provide the signature of the owner, partner, or officer along with the date to validate the information.
7. As the requesting agent, complete the next section by certifying that the information is correct to your knowledge, ensuring you provide the correct name of the company.
8. Sign the agent certification and date it, which solidifies your assurance of the accuracy of the provided data.
9. Proceed to the employee information section. Enter each employee's name, social security number, hire date, and their eligibility status.
10. For each employee, indicate 'Yes' or 'No' to confirm their eligibility and whether they have prior enrolled coverage. Be thorough and check for any mistakes.
11. Review all entered information for accuracy to ensure that each entry reflects the truthful status of your employees.
12. Once completed, you can save your changes, download the form for your records, print it, or share the form as needed.

Start completing your documents online now to ensure accuracy and efficiency!