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CIVIL SERVICE BAR ASSOCIATION SECURITY BENEFITS FUND ENROLLMENT FORM 333 WESTCHESTER AVENUE WHITE PLAINS, NY 10604 Tel.: (866) 6274617 Fax: (914) 3675793 PLEASE PRINTEMPLOYEE NAME (LAST, FIRST, MI)EMPLOYEE
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01
To fill out the enrollment form for Alicare, follow these steps:
02
Obtain the enrollment form from Alicare's website or office.
03
Read the instructions on the form carefully to understand the requirements and process.
04
Provide your personal information accurately and completely, including full name, date of birth, address, contact details, and any other requested details.
05
Indicate the type of enrollment you are applying for, such as individual or family coverage.
06
Specify the desired start date for the coverage, if applicable.
07
Provide information about any existing medical conditions or chronic illnesses, if required.
08
Include details of any dependents who need to be enrolled, such as spouse or children.
09
Sign and date the form to certify that the information provided is true and accurate.
10
Submit the completed form to Alicare through the designated method, such as online submission, mail, or in-person delivery.
11
Keep a copy of the filled-out form for your records.

Who needs enrollment form - alicare?

01
Anyone who wants to enroll in Alicare's insurance plans or programs needs to fill out the enrollment form. This includes individuals who are looking for individual coverage, families seeking coverage for their dependents, or those who wish to join any specific insurance program offered by Alicare. The enrollment form is a necessary requirement for initiating the enrollment process and receiving coverage from Alicare.
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Enrollment form - alicare is a form used to enroll in healthcare coverage provided by Alicare.
Individuals who wish to enroll in Alicare's healthcare coverage are required to file the enrollment form.
The enrollment form can be filled out online on Alicare's website or through a paper form provided by Alicare.
The purpose of the enrollment form is to collect necessary information for individuals to enroll in Alicare's healthcare coverage.
The enrollment form requires personal information such as name, address, contact information, and information about dependents if applicable.
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