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Page 1 of 3Retiree Group Health Plan
Enrollment Request Form
Please contact SCAN Health Plan if you need any information in another language or format. (Braille)
Step 1: Please fill out the application
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How to fill out retiree group health plan

How to fill out retiree group health plan
01
Gather all the necessary information and documents needed to fill out the retiree group health plan application.
02
Carefully read through the application form and instructions provided by the insurance provider or employer.
03
Fill out the personal information section accurately, including your full name, address, date of birth, and contact details.
04
Provide any necessary information about your previous health insurance coverage, if applicable.
05
Indicate your preferred coverage options and any additional benefits you may be eligible for as a retiree.
06
Review the completed application form to ensure all required fields are filled out and there are no mistakes.
07
Sign and date the application form where indicated.
08
Submit the filled-out application form to the designated insurance provider or employer office.
Who needs retiree group health plan?
01
Retiree group health plans are designed for individuals who have retired from their employment and are no longer eligible for employer-sponsored health insurance.
02
It is beneficial for retirees who do not qualify for Medicare yet and need continued health coverage.
03
Those who rely on their former employer for health benefits and want to maintain the same coverage in retirement would also need a retiree group health plan.
04
Additionally, individuals who want to supplement their Medicare coverage, as Medicare may not cover all their medical expenses, can benefit from a retiree group health plan.
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What is retiree group health plan?
A retiree group health plan is a health insurance plan that provides coverage to retirees from a previous employer.
Who is required to file retiree group health plan?
The employer or plan sponsor is required to file the retiree group health plan.
How to fill out retiree group health plan?
The retiree group health plan can be filled out by providing all necessary information about the plan, including participant information, coverage details, and any other required data.
What is the purpose of retiree group health plan?
The purpose of a retiree group health plan is to provide health insurance coverage to retirees after they leave the workforce.
What information must be reported on retiree group health plan?
The retiree group health plan must include information about the plan participants, the coverage provided, and any other required details.
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