Get the free peracare enrollment change form

Percale Enrollment/Change Form Combination Premedical and Medicare Coverage2019 Colorado Public Employees Retirement Association PO Box 5800, Denver, Colorado 802175800 1800759PERA (7372) Fax: 3038633727

How to fill out peracare enrollment change form

How to fill out peracare enrollment change form

1. To fill out the PERACare enrollment change form, follow these steps:
2. Obtain the PERACare enrollment change form from your employer or the PERACare website.
3. Enter your personal information, including your full name, address, and contact details.
4. Indicate the effective date for the enrollment change.
5. Specify the reason for the enrollment change, such as a life event or change in employment status.
6. Provide any supporting documentation or evidence if required.
7. Choose the type of enrollment change you are requesting, such as adding or removing a dependant or changing your coverage level.
8. Review the form to ensure all information is accurate and complete.
9. Sign and date the form.
10. Submit the completed form to the appropriate authority or department as indicated on the form, either through mail or electronically.
11. Keep a copy of the filled-out form for your records.

Who needs peracare enrollment change form?

1. Anyone who wishes to make changes to their PERACare enrollment needs to fill out the PERACare enrollment change form.
2. This may include employees who want to add or remove dependants from their coverage, change their coverage level, or make any other modifications to their PERACare plan.
3. It is important to check with your employer or the PERACare administration to determine if you are eligible to request changes and if this form is applicable to your specific situation.

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