Get the free Group Member Enrollment Form - TruAssure

TruAssure Insurance Company 111 Shuman Boulevard Naperville IL 60563 866 922-6004 Please print or type all answers. I understand that premiums for my coverage under the group policy will be remitted to the TruAssure Insurance Company by my Employer. EMPLOYEE / DEPENDENT / ADDITIONS / TERMINATIONS / CHANGES Please check one of the options below w Yes I want to enroll in this Group Coverage w No I do not want to enroll in this Group Coverage. THE CERTIFICATE PROVIDES DENTAL BENEFITS ONLY....

How to fill out group member enrollment form

How to fill out group member enrollment form

1. Read the instructions provided with the group member enrollment form thoroughly.
2. Gather all the necessary information and documents required for the enrollment form.
3. Start by providing the basic information of the group member, such as their name, date of birth, and contact details.
4. Next, fill in the address details of the group member including the street name, city, state, and zip code.
5. Provide the social security number or any other identification number as specified in the form.
6. Indicate the type of group membership being enrolled, along with any additional details or preferences.
7. If applicable, provide information about the group member's current health insurance coverage.
8. For dependent members, include their relationship to the primary member and any relevant details regarding their coverage.
9. Double-check all the information provided to ensure accuracy and completion of the form.
10. Sign and date the form to certify the accuracy of the information provided.
11. Submit the completed group member enrollment form as per the instructions provided.

Who needs group member enrollment form?

1. Any individual who wishes to join a particular group or organization requiring enrollment can make use of the group member enrollment form.
2. This form is commonly needed by individuals who want to become part of a health insurance group, social club, professional association, or any other similar organization.
3. Employers may also require their employees to fill out a group member enrollment form for the purpose of adding them to the company's group benefits plan.
4. Furthermore, dependents of primary members, such as spouses or children, may need to complete this form to be included in the group's coverage.

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