Get Wi Quartz Uh00674 2020-2025

This guide provides a comprehensive overview of how to efficiently fill out the WI Quartz UH00674 form online. It aims to assist users in navigating each section of the application, ensuring a smooth and accurate submission process.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to acquire the document and open it in your preferred editor.
2. Begin with the Employee Information section. Fill in your last name, first name, and Social Security Number or Tax ID Number as required. Ensure to include only your legal names, avoiding nicknames.
3. Provide your street address and any applicable apartment number. If your mailing address differs from your street address, please indicate it.
4. Enter your date of birth in the format mm/dd/yyyy and specify your gender by checking the appropriate box.
5. Indicate your marital status by checking the relevant box. Fill in your city, state, zip code, and county information.
6. Provide your primary phone number and state your primary language spoken. If applicable, include your email address.
7. Specify your primary care clinic name and select the plan you are requesting (HMO, POS, PPO) along with the type of coverage you are applying for.
8. In the Reason for Enrollment section, check the appropriate box that applies to your situation.
9. Next, complete the Employer Information section including the name of your employer group and your date of employment.
10. Provide information about your weekly hours and indicate your requested effective date of coverage.
11. Proceed to the Dependent Information section, listing any dependents to be covered. Ensure that all information matches their legal names and include relationships.
12. Fill out the Other Insurance Information section if applicable, detailing any additional insurance you or your dependents may have.
13. Review the application carefully to ensure all sections are filled accurately. After making sure everything is correct, you can save your changes, download the document, or print it for submission.

Complete your application online today for efficient health coverage.