Employee Enrollment Change Form - AWB Health Choice 2026

1. Click ‘Get Form’ to open the Employee Enrollment Change Form in the editor.
2. Begin by entering your Employer Name and Employer Number at the top of the form. This information is crucial for processing your enrollment.
3. Indicate the Qualifying Event for special enrollment by checking the appropriate box, such as Name Change or Address Change. Be sure to provide a Requested Effective Date.
4. Fill in your personal details including Employee Date of Hire, Last Name, First Name, and Social Security Number. Ensure accuracy to avoid delays.
5. For dependent information, check whether you are adding or deleting dependents and provide their details accordingly. Include any necessary legal documentation if required.
6. Review all sections carefully before signing at the bottom of the form. Your signature confirms that all provided information is accurate.

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