Get the free 2015 OPEN ENROLLMENT REQUEST FORM - University of Hartford - hartford

2015 OPEN ENROLLMENT REQUEST FORM REGULAR FULL TIME FACULTY AND STAFF Name Department YOU ARE CURRENTLY ENROLLED IN THE FOLLOWING BENEFIT PLANS: MEDICAL INSURANCE ELECTION United Healthcare STEP 1:

How to fill out 2015 open enrollment request

How to fill out 2015 open enrollment request:

1. Start by obtaining the 2015 open enrollment request form from your employer or health insurance provider.
2. Carefully read through the instructions provided on the form to ensure you understand the requirements and deadlines.
3. Begin by entering your personal information accurately, including your full name, date of birth, and social security number.
4. Fill in any additional information that may be required, such as your contact details and current address.
5. Next, provide information about your previous health insurance coverage, if applicable. This may include details about your previous insurance provider and the type of plan you were enrolled in.
6. Indicate whether you are requesting coverage for yourself or for dependents. If adding dependents, provide their names, dates of birth, and relationship to you.
7. Proceed to choose the type of health insurance plan you wish to enroll in for the year 2015. There may be different options available, such as HMO or PPO plans.
8. If your employer offers multiple health insurance plans, carefully review the details and compare them before making your selection.
9. Consider any additional coverage options that may be available, such as dental or vision insurance, and indicate your preferences accordingly.
10. Make sure to review the completed form for any errors or omissions before submitting it.

Who needs 2015 open enrollment request:

1. Employees who are eligible for health insurance coverage through their employer.
2. Individuals who currently do not have adequate health insurance and wish to enroll in a plan for the year 2015.
3. Dependents of employees who are eligible for coverage may also need to complete the open enrollment request form if they wish to be included in the health insurance plan.

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What is open enrollment request form?

The open enrollment request form is a document used to request a change in benefits or enrollment in a health insurance plan outside of the regular enrollment period.

Who is required to file open enrollment request form?

Employees who wish to make changes to their benefits or enroll in a new health insurance plan outside of the regular enrollment period are required to file the open enrollment request form.

How to fill out open enrollment request form?

To fill out the open enrollment request form, employees must provide their personal information, select the desired changes to benefits or health insurance plan, and submit the form to the HR department.

What is the purpose of open enrollment request form?

The purpose of the open enrollment request form is to allow employees to make changes to their benefits or enroll in a new health insurance plan outside of the regular enrollment period.

What information must be reported on open enrollment request form?

The open enrollment request form must include personal information of the employee, details of desired changes to benefits or health insurance plan, and any supporting documentation.