Enrollment 2 14 2026

1. Click ‘Get Form’ to open the enrollment 2 14 document in the editor.
2. Begin by filling in your employer's group name and number, along with your date of hire and position/title. This information is crucial for processing your application.
3. In Section 1, check the applicable company and write in the product that applies to you. If enrolling in an HSA plan, ensure you understand the implications of opening a Health Savings Account.
4. For Section 2, indicate your reason for application by checking all that apply. Be sure to provide dates where necessary, such as marriage or loss of eligibility.
5. In Section 3, select your desired coverage option from the available choices. This will determine who is covered under your plan.
6. Complete Sections 4 and 5 with accurate employee and family information. Ensure all names, social security numbers, and PCP details are correct.
7. If applicable, fill out Section 6 regarding other insurance coverage. Provide details about any previous plans you or your dependents have had.
8. Finally, review all sections for accuracy before signing the employee statement in Section 8. Your signature confirms that all provided information is true.

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