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STATE OF MARYLAND RETIREEHEALTH BENEFITS ENROLLMENT AND CHANGE FORM JANUARY 2018DECEMBER 2018 PERSONALDATAPLEASE PRINT CLEARLYNAME: LASTFIRSTMIADDRESS: APT/CONDO: CITY: STATE: ZIP CODE: SEX:MaleFemaleLEGALMARITAL
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How to fill out cy18 retiree enrollment form
How to fill out cy18 retiree enrollment form
01
To fill out the CY18 retiree enrollment form, follow these steps:
02
Start by reading the instructions provided with the form carefully.
03
Fill in your personal information accurately, including your full name, date of birth, and contact details.
04
Provide information about your current medical coverage, such as whether you have Medicare or any other health insurance.
05
Indicate whether you are choosing a new plan or staying with your current plan.
06
If you are selecting a new plan, carefully review the available options and choose the one that best suits your needs.
07
Complete the sections related to prescription drug coverage, ensuring you provide accurate information about any medications you take.
08
If you have any dependents that need coverage, fill in their details in the appropriate sections.
09
Review the form thoroughly to make sure all the information provided is accurate and complete.
10
Sign and date the form to certify its accuracy.
11
Submit the completed form to the appropriate authority or follow any specific submission instructions provided.
Who needs cy18 retiree enrollment form?
01
The CY18 retiree enrollment form is needed by retirees who are eligible for certain retirement benefits and wish to enroll in a specific healthcare plan or make changes to their existing plan for the calendar year 2018.
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