Ga 51340 pp 2025

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The document is a Group Employee and Individual Application and Enrollment Form for Humana, intended for employers with 1-100 employees in Illinois. It outlines the process for enrolling in various health insurance plans, including HMO, PPO, dental, vision, life, and disability coverage. The form requires detailed personal information from applicants, including qualifying events for enrollment, prior coverage details, and health history. It emphasizes the importance of not canceling existing coverage until acceptance is confirmed by Humana.

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Versions	Form popularity	Fillable & printable
2014	4.9 Satisfied (264 Votes)

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