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Get Regence 5275wa 2017-2025
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How to fill out the Regence 5275WA online
Filling out the Regence 5275WA form online can streamline your enrollment or change process. This guide provides clear, step-by-step instructions to help you complete each section of the form effectively.
Follow the steps to complete the Regence 5275WA form online.
- Press ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Begin by filling out the group information at the top of the form. Input the group number, subgroup, and class as indicated by your employer. Ensure these fields are filled accurately.
- Enter your personal details including last name, first name, middle initial, full-time date of hire, and original date of hire. These must be provided in mm/dd/yyyy format.
- Next, input your eligibility waiting period start date and the number of hours you work per week to establish your eligibility for coverage.
- Fill in your mailing and physical addresses. If both are the same, indicate that by checking the appropriate box.
- Select your primary language and provide your daytime phone number and email address for contact purposes.
- Indicate your marital status by selecting the appropriate box provided. If applicable, additional documentation may be required for domestic partners.
- If you are enrolling or making changes, fill out the relevant sections regarding the requested effective date and specific events, such as a marriage or the birth of a child.
- Choose your plan selection for medical and/or dental coverage. Select the relevant metal level and any additional plan options available through your group.
- List all members you are adding, changing, or terminating coverage for by providing their names, genders, and social security numbers. Be attentive to fill in the relation and date of birth fields as well.
- Complete the section for selecting your primary care physician by providing the names and information of the doctors you prefer for your coverage.
- If applicable, select your desire for COBRA or non-COBRA continuation enrollment and provide the reason for entitlement and the date of the event.
- Detail your current and prior coverage information, ensuring to attach any required court documentation for dependent coverage.
- Finally, sign and date the application to confirm the information is accurate and complete. Ensure all required fields are properly filled to avoid delays in processing your application.
Complete your Regence 5275WA form online today to ensure a smooth enrollment process.
Regence provides a variety of plan types, including both PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) options. The choice between these plans often depends on your healthcare needs and preferences. For those considering the Regence 5275WA plan, understanding the differences between PPOs and HMOs can help you choose the best coverage that suits your lifestyle and healthcare requirements.
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