Open enrollment occurs every May 2025

1. Click ‘Get Form’ to open the Open Enrollment Application in the editor.
2. Begin with Section A: Employee Information. Fill in your last name, first name, birthdate, and social security number. Ensure all details are accurate to avoid delays.
3. Proceed to Section B: Application Type. Select whether you are applying for new enrollment or open enrollment.
4. In Section C: Type of Coverage, choose your desired medical coverage plan and specify if you want additional options like dental or vision coverage.
5. Complete Section D: Coverage Information by listing any dependents you wish to cover under your plan, including their personal details.
6. Review Section E: Medical Information carefully. Answer all health-related questions truthfully as they may affect your eligibility.
7. Finally, sign and date the application in the designated area at the end of the form before submitting it electronically.

Start filling out your Open Enrollment Application today using our platform for a seamless experience!