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DISC III ENROLLMENT FORM (DO NOT use for Kaiser members, use Kaiser Permanent enrollment form for Kaiser members) (Type or print clearly in black ink) SECTION I: SELECTED COVERAGE REQUIRED (DISTRICT

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How to fill out new benrollment formb

How to fill out a new benrollment formb:

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Start by carefully reading the instructions provided on the form. This will help you understand the purpose of each section and the information required.

02

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Move on to the enrollment details section and fill in the necessary information, such as the effective date of the benrollment, the type of coverage you are requesting, and any additional coverage options you may be interested in.

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