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EMPLOYEE GROUP ENROLLMENT APPLICATION Wisconsin Physicians Service Insurance Corporation (WPS) (Insurer) or Third Party Administrator (TPA) does NOT guarantee approval of this application for any

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How to fill out employee group enrollment application

01

Step 1: Obtain a copy of the employee group enrollment application from your employer.

02

Step 2: Read the instructions on the application form carefully to ensure that you understand all the requirements.

03

Step 3: Fill out the personal information section with accurate and up-to-date details, including your full name, address, contact information, and social security number.

04

Step 4: Provide information about your eligible dependents, if applicable, such as their names, dates of birth, and relationship to you.

05

Step 5: Indicate the type of coverage you are enrolling for, such as medical, dental, or vision, and select the appropriate plan option.

06

Step 6: Fill in the necessary information for each dependent you are enrolling, if applicable.

07

Step 7: Review the completed application form for any mistakes or missing information and make necessary corrections.

08

Step 8: Sign and date the application form as required to certify that the information provided is accurate and complete.

09

Step 9: Submit the filled-out application form to your employer or the designated HR department within the specified timeframe.

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Step 10: Keep a copy of the completed application form for your records.

Who needs employee group enrollment application?

01

Employees who are eligible for group healthcare benefits provided by their employer need to fill out the employee group enrollment application.

02

This includes new hires who are joining the company, existing employees who want to enroll in or make changes to their existing coverage, as well as employees who have experienced a qualifying life event that allows them to make changes to their benefits selection.

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What is employee group enrollment application?

Employee group enrollment application is a form used by employers to enroll their employees in group health insurance plans.

Who is required to file employee group enrollment application?

Employers are required to file employee group enrollment applications for their employees.

How to fill out employee group enrollment application?

Employee group enrollment applications can be filled out online or by completing a paper form provided by the insurance company.

What is the purpose of employee group enrollment application?

The purpose of employee group enrollment application is to enroll employees in group health insurance plans provided by the employer.

What information must be reported on employee group enrollment application?

Employee group enrollment applications typically require information such as employee names, dates of birth, social security numbers, and benefit selections.

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