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Enroll or re-enroll your adult dependent (age 19-26) in the IBEW 292 Health Care Plan. Complete the application to ensure proper coverage.
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What is Adult Dependent Enrollment Application Form?

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The adult dependent enrollment application is a form used to enroll adult dependents in health insurance or benefit programs.
Individuals who wish to add an adult dependent, such as a child over the age of 26 or a partner, to their health insurance coverage are required to file this application.
To fill out the application, provide personal information for both the primary applicant and the adult dependent, including names, addresses, Social Security numbers, and any other required documentation.
The purpose of the adult dependent enrollment application is to officially register an adult dependent for health insurance coverage or benefits under a policyholder's plan.
Information that must be reported includes personal details like the names, dates of birth, addresses, Social Security numbers of the adult dependent, as well as the policyholder's information.
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