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MEA Health Plans
Member Enrollment/Member Change Form
Section 1: Employer information
Company numerous no. (if existing group)AddressCityDate of hire (MM/DD/YYY)State Date of rehire (if applicable)
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What is if existing group?
An existing group is a group that has already been established or in existence.
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The entity or individual who is responsible for the group is required to file if existing group.
How to fill out if existing group?
To fill out if existing group, the entity or individual must provide accurate and up-to-date information about the group.
What is the purpose of if existing group?
The purpose of if existing group is to ensure that all necessary information about the group is documented and reported.
What information must be reported on if existing group?
Information such as group members, activities, and financial details must be reported on if existing group.
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