Get the free 2015 Excellus Group Enrollment Form - Lifetime Assistance - lifetimeassistance

DO NOT USE FOR INTERNAL PURPOSES ONLY P.O. Box 22999, Rochester, NY 14692 A nonprofit independent licensee of the Blue Cross Bluesier Association HIS ID# EC Lifetime Assistance GROUP ENROLLMENT FORM

How to fill out 2015 excellus group enrollment

1. The 2015 Excellus Group Enrollment form is needed for individuals or families who want to enroll in a group health insurance plan offered by Excellus BlueCross BlueShield for the year 2015.
2. To fill out the form, start by providing your personal information such as your full name, address, date of birth, and social security number. This information is necessary for identification and enrollment purposes.
3. Next, indicate whether you are enrolling as an individual or as part of a family plan. If you are enrolling as part of a family, you will need to provide the relevant information for each family member who will be covered under the plan.
4. Choose the type of plan you wish to enroll in from the options provided by Excellus. This could include different levels of coverage such as bronze, silver, gold, or platinum, depending on your needs and budget.
5. Indicate whether you currently have any other health insurance coverage, such as through an employer or another provider. This information helps to coordinate benefits and avoid any potential duplication of coverage.
6. Provide details of your primary care physician, including their name, address, and contact information. This ensures that you have a designated primary point of contact for your healthcare needs.
7. Make sure to review the terms and conditions of the group health insurance plan carefully before signing the form. This includes understanding the coverage limits, copayments, deductibles, and other important details related to the plan.
8. After completing all the required sections of the form, sign and date it to confirm your enrollment and agreement to the terms and conditions.
9. Once the form is completed, submit it to Excellus BlueCross BlueShield through the designated channels specified by the company. This may involve mailing the form or submitting it electronically, depending on the instructions provided.
10. Keep a copy of the filled-out enrollment form for your records. This can serve as proof of your enrollment and can be referred to in case there are any questions or issues related to your coverage.

Remember, the specific instructions and requirements may vary depending on the Excellus group health insurance plan you are enrolling in. It is always recommended to carefully read and follow the instructions provided with the enrollment form to ensure smooth and accurate completion.

For pdfFiller’s FAQs

What is excellus group enrollment form?

The Excellus group enrollment form is a document used to enroll a group of individuals in an Excellus healthcare plan.

Who is required to file excellus group enrollment form?

Employers or group administrators are required to file the Excellus group enrollment form on behalf of their employees or members.

How to fill out excellus group enrollment form?

The Excellus group enrollment form can be filled out online or submitted by mail. It requires information about the group, the individuals to be enrolled, and their coverage preferences.

What is the purpose of excellus group enrollment form?

The purpose of the Excellus group enrollment form is to officially enroll a group of individuals in an Excellus healthcare plan and ensure they have the necessary coverage.

What information must be reported on excellus group enrollment form?

The Excellus group enrollment form requires information such as group name, group number, employee/member details, coverage selections, and payment information.

How do I fill out the 2015 excellus group enrollment form on my smartphone?

You can easily create and fill out legal forms with the help of the pdfFiller mobile app. Complete and sign 2015 excellus group enrollment and other documents on your mobile device using the application. Visit pdfFiller’s webpage to learn more about the functionalities of the PDF editor.

How can I fill out 2015 excellus group enrollment on an iOS device?

pdfFiller has an iOS app that lets you fill out documents on your phone. A subscription to the service means you can make an account or log in to one you already have. As soon as the registration process is done, upload your 2015 excellus group enrollment. You can now use pdfFiller's more advanced features, like adding fillable fields and eSigning documents, as well as accessing them from any device, no matter where you are in the world.

Can I edit 2015 excellus group enrollment on an Android device?

You can make any changes to PDF files, such as 2015 excellus group enrollment, with the help of the pdfFiller mobile app for Android. Edit, sign, and send documents right from your mobile device. Install the app and streamline your document management wherever you are.