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Get Hi Ec-1 2003
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How to fill out the HI EC-1 online
The HI EC-1 is an essential enrollment form for active employees seeking health benefits. This guide provides a clear, step-by-step approach to filling out the form online to ensure a smooth submission process.
Follow the steps to accurately complete the HI EC-1 form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by specifying the event in Section 1. This could include events such as birth, marriage, or loss of coverage.
- In Section 2, enter the event date in the MM/DD/YY format.
- Complete Section 3a with the employee's last name, first name, and middle initial. Ensure that Section 3b reflects the employee's Social Security number accurately.
- Include the employee's birth date in Section 3d, again in the MM/DD/YY format.
- In Section 3f, provide the city of residence. Section 3g requires the state.
- If applicable, enter the spouse's Social Security number in Section 4, only if the spouse is a state or county employee or retiree.
- List dependents' information in Section 5a, including first name, middle initial, and last name. Include their birthdates in Section 5b.
- Select the marital status in Section 3e by marking 'Married' or 'Single'.
- Provide contact information in Section 3h and 3i, filling in phone numbers for both work and home.
- In the section for plan selections, choose the appropriate benefit plans by checking the relevant boxes for Medical, Dental, and Vision options.
- Complete Section 10 if you are a state employee and need to enroll in the Premium Conversion Plan.
- Use Section 11 for any comments that may be relevant to your application.
- Sign and date the certification in Section 12, affirming that all provided information is accurate.
- Ensure that the DPO signature and date in Section 13 are completed, certifying eligibility.
- In Sections 14 and 15, enter the department ID and other relevant departmental information as needed.
- Finally, save your changes, download, print, or share the completed form as necessary.
To ensure your health benefits enrollment is processed timely, complete the HI EC-1 form online today.
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No, you cannot complete an I-9 Form for yourself; this process requires a designated employer or authorized representative to complete Section 2. The employer must review and verify your documents to confirm work eligibility. To navigate this process smoothly, consider using uslegalforms, where you can find templates and guidance that simplify the I-9 completion for both employees and employers.
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