What is Form HR BEN 372?
Form HR BEN 372 is created by Metropolitan Transportation Authority. It is called the Open Enrollment/Change Form. This form must be completed by those individuals who need to change their health insurance or enroll in a new one.
What is Form HR BEN 372 for?
MTA designed this form for such purpose as enrollment in a new health insurance or making changes in the old one. Completing and filing this document, you have a chance to obtain more health insurance benefits. If you need help and have some questions, you may contact the Business Service Center. The form is easy to complete and consists of only 2 pages.
When is Form HR BEN 372 Due?
This form is due by January 1st, 2017. If you failed to file it by this date, you must wait till the MTA offers a new form template for completing.
Is HR BEN 372 Form Accompanied by Other Forms?
You must attach such copies as your most recent tax return and proof of ownership (any type you have).
What Information do I Include in Form HR BEN 372?
The form consists of seven sections. Section 1 includes general information and instructions. There are no fields to be filled in. You will find contacts of support service and the fax number where to send the form. In Section 2 you indicate the employee information: name, phone, BSC ID, email, etc. Section 3 is devoted to the coverage election. The dependent information must be provided in the fourth section (name, SSN, spouse, children, gender and date of birth). Section 5 is the Authorization that includes the employee’s signature and date. In Section 6, you indicate the documentation you need to attach and in the last section you may check the terms and conditions.
