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OPTIONS COUNSELING/CHOICE FORM Name: DOB: SS #: MCO: Address: City, State, Zip: Medicaid #: Telephone #: initial / CURRENT SERVICE(S): I would like to keep my services the same. However, I know that

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How to fill out annual choice form

01

Step 1: Obtain the annual choice form from your employer or insurance provider.

02

Step 2: Read the instructions and requirements carefully to ensure you meet all the eligibility criteria.

03

Step 3: Fill in your personal details, such as your name, address, and contact information.

04

Step 4: Provide information about your current insurance coverage, if any.

05

Step 5: Select the desired coverage options or changes for the upcoming year.

06

Step 6: Double-check all the information provided to ensure accuracy and completeness.

07

Step 7: Sign and date the form.

08

Step 8: Submit the completed annual choice form to your employer or insurance provider within the specified deadline.

09

Step 9: Keep a copy of the form for your records.

Who needs annual choice form?

01

Anyone who is eligible for employer-provided insurance or has existing insurance coverage needs to fill out the annual choice form.

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What is annual choice form?

The annual choice form is a document that allows individuals to choose between different options for their annual benefits.

Who is required to file annual choice form?

All employees who are eligible for annual benefits are required to file the annual choice form.

How to fill out annual choice form?

Employees can fill out the annual choice form online or in person with their HR department.

What is the purpose of annual choice form?

The purpose of the annual choice form is to allow individuals to select their annual benefits options.

What information must be reported on annual choice form?

The annual choice form requires information such as medical plan selections, dental coverage, and other benefit options.

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