Get the free 20182019 pre-retired enrollment form - PSEA
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THE PENNSYLVANIA STATE EDUCATION ASSOCIATION
NATIONAL EDUCATION ASSOCIATION
2019 ENROLLMENT FORM 2020
COUNTY FOR RETIRED ENROLLMENTS NAMEFIRST NAMEMIDDLE INITIALIZED CODE CELL NUMBERED CODE HOME NUMBERSTATECITYSTREET
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How to fill out 20182019 pre-retired enrollment form
How to fill out 20182019 pre-retired enrollment form
01
Obtain a copy of the 20182019 pre-retired enrollment form from your employer or healthcare provider.
02
Read the instructions carefully to understand the information needed to complete the form.
03
Gather all the necessary personal and healthcare information, such as your full name, address, date of birth, and insurance policy details.
04
Fill in the required fields on the form accurately and legibly. Use black ink and write in capital letters if necessary.
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Sign and date the form as required, and provide any additional documentation requested.
09
Make a copy of the filled-out form for your records before submitting it.
10
Submit the completed form to your employer or healthcare provider by the specified deadline.
Who needs 20182019 pre-retired enrollment form?
01
Individuals who are planning to retire and enroll in a pre-retired healthcare plan for the year 20182019.
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