Get the free Benefit Election Form

This form is used to elect benefits for the Long Term Care insurance policy provided by Unum Life Insurance Company of America. It collects personal information and the selection of insurance plans

How to fill out benefit election form

How to fill out Benefit Election Form

1. Begin with personal information: Fill in your name, address, and employee ID.
2. Review the benefits offered: Read through the available options for health insurance, retirement plans, etc.
3. Select your desired benefits: Indicate which benefits you wish to elect by marking the appropriate boxes.
4. Provide dependent information: If applicable, include details for any dependents you wish to enroll.
5. Acknowledge any changes: If changing benefits, review the consequences and acknowledge them.
6. Sign and date the form: Ensure that you sign and date the form to validate your election.

Who needs Benefit Election Form?

1. New employees enrolling in benefits for the first time.
2. Current employees making changes to their existing benefits during open enrollment.
3. Employees who have experienced qualifying life events (such as marriage or birth of a child).
4. Individuals needing to update or confirm dependent coverage.

For pdfFiller’s FAQs

What is Benefit Election Form?

The Benefit Election Form is a document used by employees to select or change their benefits, such as health insurance, retirement plans, and other employee benefits.

Who is required to file Benefit Election Form?

Employees who are enrolling in, changing, or verifying their benefit selections for the first time or during open enrollment typically need to file a Benefit Election Form.

How to fill out Benefit Election Form?

To fill out the Benefit Election Form, employees must provide personal information, select their desired benefits from the options provided, and sign the form to confirm their choices.

What is the purpose of Benefit Election Form?

The purpose of the Benefit Election Form is to ensure that employees make informed choices regarding their benefits and to formally document those selections for payroll and benefits administration.

What information must be reported on Benefit Election Form?

The information that must be reported on the Benefit Election Form includes the employee's personal details (such as name and employee ID), selected benefits (like health insurance plans), dependent information, and any changes or additions to existing benefits.