Sebb-metlife-enrollment-form 2025

1. Click ‘Get Form’ to open the sebb-metlife-enrollment-form in the editor.
2. Begin by filling out the Employer Section. Indicate if you are a new hire or if there is a qualifying event, and select your employment status (Full Time, Part Time, Retiree). Enter the Benefit Effective Date and Date of Hire.
3. In the Member Information section, provide your last name, first name, street address, employee ID number, city/state/zip code, home phone number, marital status, date of birth, gender, and social security number.
4. For Medical/Prescription Drug Coverage Election, choose one plan from the options provided. Repeat this for Dental and Vision Coverage Elections.
5. Complete the Supplemental Life Insurance Coverage Election by selecting whether to enroll or decline coverage for yourself and dependents.
6. If applicable, fill out the Voluntary Short Term Disability section by choosing your plan election and coverage amount.
7. For Flexible Spending Account Coverage Election, indicate whether to enroll or decline and specify the amounts for medical reimbursement and dependent care accounts.
8. Provide information for any dependents under Dependent Information. Ensure all details are accurate.
9. Finally, review the Agreement and Signature section. Sign and date the form to confirm accuracy before submission.

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