Get the free State Retiree Medical Form - Vermont State Treasurer - vermonttreasurer
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ENROLLMENT/CHANGE FORM RETIREE MEDICAL RETIREE INFORMATION Name: Return all completed forms to: STATE OF VERMONT RETIREMENT DIVISION 109 STATE STREET MONTPELIER, VT 056096901 Retiree ID: Date of Birth:
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How to fill out state retiree medical form
How to fill out state retiree medical form
01
Read the instructions provided with the state retiree medical form thoroughly.
02
Gather all necessary personal information such as name, address, social security number, and date of birth.
03
Fill in the required personal information accurately and legibly.
04
Provide details about your current health insurance coverage, if applicable.
05
If you have any dependents, provide their information as asked in the form.
06
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07
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08
Submit the form through the specified submission method, such as mail or online.
09
Keep a copy of the filled-out form for your records.
Who needs state retiree medical form?
01
State retirees who are eligible for medical benefits.
02
State employees transitioning into retirement.
03
Spouses and dependents of state retirees in need of medical coverage.
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What is state retiree medical form?
The state retiree medical form is a document that retirees fill out to enrole in the state's retiree medical benefits program.
Who is required to file state retiree medical form?
Retirees who want to participate in the state's retiree medical benefits program are required to file the state retiree medical form.
How to fill out state retiree medical form?
To fill out the state retiree medical form, retirees must provide personal information, medical history, and any other required details as outlined in the form.
What is the purpose of state retiree medical form?
The purpose of the state retiree medical form is to collect necessary information from retirees to enroll them in the state's retiree medical benefits program.
What information must be reported on state retiree medical form?
The state retiree medical form typically requires information such as personal details, medical history, contact information, and any other pertinent data requested by the program.
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