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MEDICAL OPEN ENROLLMENT September 10 through October 5, 2012, OPEN ENROLLMENT CHANGES ARE EFFECTIVE JANUARY 1, 2013, A DATE-STAMPED COPY OF THIS FORM WILL BE PROVIDED TO YOU AS VERIFICATION MEDICAL
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How to fill out the 2012 OE Formdoc:
01
Obtain the 2012 OE Formdoc: The first step is to obtain the 2012 OE Formdoc. You can download it from the official website or contact your employer or health insurance provider to request a copy.
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Personal information: Begin by filling out the personal information section. Provide your full name, address, date of birth, and social security number. Double-check the accuracy of this information before moving on.
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Employer information: If the form requires information about your employer, provide the details requested, including the company name, address, and federal employer identification number (FEIN). This information can usually be found on your W-2 or other employment documents.
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Insurance coverage details: Next, provide information about your insurance coverage. This may include the name of the insurance provider, policy number, and effective dates of coverage. If you have multiple policies, provide information for each one separately.
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Dependent information: If you have dependents who are covered under your insurance, provide their details as requested. This may include their names, dates of birth, and social security numbers.
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Signature: Once you have completed all the required sections and reviewed your answers, sign and date the form. Your signature serves as confirmation that the information provided is accurate to the best of your knowledge.
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