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Tips For Completing Forms

Tips For Completing Forms

Enrollment, Change and Termination Forms

Submitting incomplete forms causes processing delays. The following tips should help ensure a smooth, automated enrollment process.

  • Please complete all applicable fields on the form. Do not line through or use "N/A" in fields that are not applicable. Leave those fields blank.
  • Certain fields are required for processing. These are:
    • Group Number
    • Group Name
    • Employee/Dependent Name(s)
    • Date(s) of Birth
    • Social Security Number
    • Gender
    • Coverage Information
  • Carefully follow the instructions provided with the form(s).
  • Black or blue ink is preferred. Do not use red ink or pencil.
  • Clearly print inside individual boxes.
  • Use the month, day and full year (for example, 07172001 for July 17, 2001).
  • Punctuation marks such as periods, commas, or dollar signs should not be used.
  • A dash should only be used in a name if it is actually part of the legal name.
  • After completing the form, review it carefully to assure all applicable fields were completed accurately.
  • If there are more dependents than are allowed on the form, use another enrollment form. Complete the dependent section only and attach it to the initial form.
  • Please do not write notes on the forms. Use a separate sheet of paper to relay any information.