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Click ‘Get Form’ to open the Employee Benefits Enrollment Form - KTimeHR in the editor.
Begin by filling out your personal information in Section I. Include your last name, first name, middle initial, and contact details such as phone number and email address.
In Section II, indicate the type of request you are making—whether it’s for a new hire, a change in status, or during open enrollment. Be sure to provide effective dates where required.
Proceed to Section III to list all individuals you wish to cover under your benefits. For each dependent, specify their relationship to you and select whether you are adding or removing coverage.
In Section IV, choose your desired benefits from medical insurance options and other plans available. Make sure to select only one plan per category.
Finally, review all sections for accuracy before signing at the end of the form. Once completed, submit the form as instructed.

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