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KIMBERLY SCHOOL DISTRICT OPEN ENROLLMENT APPLICATION Date Requested School Zoned School Current School Student Name Last Street AddressGradeSchool year for requesters City Update of Birthmark/Legal

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How to fill out open enrollment information

01

Step 1: Gather all necessary personal information including social security number, date of birth, and dependent information.

02

Step 2: Review all available health insurance plans and carefully consider which plan best fits your needs.

03

Step 3: Complete the enrollment form accurately, providing all required information such as contact details, current coverage status, and expected coverage start date.

04

Step 4: If applicable, choose additional coverage options such as dental or vision plans.

05

Step 5: Ensure that you understand all terms and conditions, including cost and coverage details, before finalizing your enrollment.

06

Step 6: Submit your completed enrollment form by the designated deadline.

07

Step 7: Keep a copy of your enrollment form for your records.

Who needs open enrollment information?

01

Anyone who is eligible and wishes to enroll in a health insurance plan during the open enrollment period needs to provide open enrollment information.

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What is open enrollment information?

Open enrollment information refers to the period during which individuals can enroll in or change their health insurance plans without facing penalties or restrictions.

Who is required to file open enrollment information?

Employers offering health insurance plans to their employees are required to file open enrollment information.

How to fill out open enrollment information?

To fill out open enrollment information, individuals or employers need to provide relevant personal and insurance details on the designated forms provided by their health insurance provider.

What is the purpose of open enrollment information?

The purpose of open enrollment information is to inform eligible individuals of their options for health insurance coverage and to ensure that they can undergo necessary plan changes.

What information must be reported on open enrollment information?

Information that must be reported includes the names and social security numbers of enrolled individuals, plan options, coverage details, and any changes in enrollment.

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