Personal Health Application Instructions Clear Form - juniata 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the Employer Section. Ensure all fields are filled completely, as incomplete forms may delay processing.
3. In Section #1, check the appropriate boxes indicating who requires an application for evidence of insurability.
4. Proceed to Section #2, 'Coverage Summary.' Fill in coverage amounts for each applicant, ensuring accuracy based on your employee records.
5. Once the Employer Section is complete, forward the form to the employee for their section.
6. The employee must enter their name and answer all health questions accurately. Missing information can lead to delays.
7. Both sections must be signed and dated by the employee and spouse (if applicable) before submission.

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