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This form is used for retirees, disabled individuals, and surviving spouses of the State of Arizona to enroll in benefit options for the year 2010. It allows for the selection of medical, dental,
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How to fill out STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD 2010 SPECIAL ENROLLMENT FORM
01
Obtain the STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD 2010 SPECIAL ENROLLMENT FORM from the official website or your HR department.
02
Start by entering your personal information at the top of the form, including your name, address, and contact information.
03
Provide your Social Security number and any relevant identification numbers as required.
04
Review the benefit options available to retirees and mark your selections clearly.
05
If you are enrolling dependents, fill out their information accurately in the designated section.
06
Double-check all the information filled out for accuracy.
07
Sign and date the form in the appropriate fields, confirming that all information is true and complete.
08
Submit the completed form to the appropriate HR or benefits office, either by mail or electronically, as instructed.
Who needs STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD 2010 SPECIAL ENROLLMENT FORM?
01
Retired employees of the State of Arizona who wish to enroll in or change their benefit options.
02
Individuals who are on Long Term Disability (LTD) and need to make benefit selections.
03
Dependents of retirees who may need to be included in benefit coverage.
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People Also Ask about
What is the phone number for Social Security retirement benefits?
You can apply: Online; or. By calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office.
What is the phone number for food stamp renewal in Arizona?
You can renew your benefits online with a Health-e-Arizona Plus account. If you'd rather renew in person, call your caseworker, local office, or the Arizona SNAP hotline (1-855-432-7587) to find out how.
How many years do you have to work for the state of Arizona to retire?
Normal retirement is defined as either (1) reaching age 65, (2) reaching age 62 along with at least 10 years of ASRS service credit, or (3) earning at least 80 points.
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What is STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD 2010 SPECIAL ENROLLMENT FORM?
The STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD 2010 SPECIAL ENROLLMENT FORM is a document used by retirees and those on long-term disability to enroll or make changes to their health benefits outside of the regular enrollment periods.
Who is required to file STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD 2010 SPECIAL ENROLLMENT FORM?
Individuals who are retirees or are receiving long-term disability benefits from the State of Arizona and wish to enroll in or modify their benefit options are required to file this form.
How to fill out STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD 2010 SPECIAL ENROLLMENT FORM?
To fill out the form, individuals need to provide personal information such as their name, contact information, and details regarding their current benefits. They should follow the instructions provided on the form carefully to ensure accurate submission.
What is the purpose of STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD 2010 SPECIAL ENROLLMENT FORM?
The purpose of this form is to enable retirees and long-term disability beneficiaries to enroll in or make changes to their health benefits, ensuring they have access to necessary medical care and support.
What information must be reported on STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD 2010 SPECIAL ENROLLMENT FORM?
The information that must be reported includes the individual’s personal details, current benefit selections, any changes being requested, dependent information, and acknowledgment of understanding the terms and conditions related to the benefits.
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