Get the free MEDICAL and DENTAL ENROLLMENT APPLICATION - lanecounty
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LANE COUNTY Jan 2014 Open Enrollment COBRA / RETIREE MEDICAL and DENTAL ENROLLMENT APPLICATION Please type or print legibly in ink. Complete all applicable sections. Section 1 Purpose of This Form
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How to fill out medical and dental enrollment
How to fill out medical and dental enrollment:
01
Start by obtaining the necessary forms from your employer or insurance provider. These forms may also be available online.
02
Carefully read through the instructions provided with the enrollment forms to ensure that you understand the process and requirements.
03
Fill in all the required personal information, such as your name, address, date of birth, and social security number.
04
Provide details about your current health insurance coverage, if applicable. This information may include the name of your current insurance provider and policy number.
05
Indicate whether you are enrolling as an individual or including any dependents, such as a spouse or children. If enrolling dependents, provide their necessary personal information as well.
06
Select the desired medical and dental options available to you. This may involve choosing between different plans, coverage levels, and premiums.
07
If you have any specific health conditions or medical needs, ensure that you provide this information accurately. It can help determine appropriate coverage and services.
08
Review all the information you have filled out to make sure everything is correct and complete. Don't forget to sign and date the enrollment forms.
09
Submit the completed enrollment forms to your employer or insurance provider by the specified deadline. Be aware of any additional documentation that may be required.
10
Keep a copy of the completed enrollment forms for your records.
Who needs medical and dental enrollment:
01
Employees who are eligible for health insurance benefits through their employer typically need to enroll in medical and dental coverage.
02
Individuals who are self-employed or do not have access to employer-sponsored health insurance may need to obtain individual medical and dental coverage.
03
Dependents, such as spouses and children, may need to be enrolled in medical and dental plans along with the primary policyholder. This ensures that their healthcare needs are covered as well.
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