18003237268 2026

1. Click ‘Get Form’ to open the LINECO FAMILY ENROLLMENT CARD in the editor.
2. Begin by entering your Employee Name and Social Security Number in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in your Employee Address, including Street, City, State, and Zip Code. Provide a valid Phone Number and Cell Phone Number for contact purposes.
4. Indicate your Date of Birth and select your Sex by circling M or F. This information is essential for enrollment verification.
5. Complete the Marital Status section by circling the appropriate option. If married, provide Spouse Name, Date of Birth, and Social Security Number.
6. List all dependent children under age 26 by filling in their Full Legal Name, Sex, Relationship to you, Social Security Number, Birthdate, and Employment status.
7. If applicable, provide details about any additional medical coverage by circling YES or NO and supplying necessary documentation if YES is selected.
8. Finally, review all entered information for completeness before signing and dating the form at the bottom.

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