GP42441-5 doc 2026

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The document is an Employee Enrollment and Waiver form for Principal Life Insurance Company, detailing the process for employees to enroll in various insurance benefits such as medical, dental, vision, and life insurance. It includes sections for personal information, dependent details, coverage options, beneficiary designations, and important notices regarding preexisting conditions and special enrollment rights. Employees must complete the form accurately to ensure eligibility for coverage.

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Click ‘Get Form’ to open the GP42441-5 document in the editor.
Begin by filling out your personal information in the 'Employee Information' section. Enter your name, mailing address, social security number, and date of employment.
Indicate whether you have an eligible spouse or child by selecting 'yes' or 'no'. Provide details such as salary amount, hours worked per week, and job occupation.
In the 'Benefit Options' section, select your desired coverage options for medical, dental, vision, and disability benefits by choosing 'elect' or 'decline'.
Complete the 'Eligible Dependent Information' if you are electing benefits for a spouse or children. Fill in their names, birth dates, and social security numbers.
Finally, review all entered information for accuracy before signing at the bottom of the form. Ensure you understand all statements regarding coverage and eligibility.

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