Form A10387 State Health Benefits Program Enrollment Form for Retirees, Survivors and Ltd Participants - Virginia

Form A10387 State Health Benefits Program Enrollment Form for Retirees, Survivors and Ltd Participants - Virginia

What Is Form A10387?

This is a legal form that was released by the Virginia Department of Human Resource Management - a government authority operating within Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: Who is eligible to use Form A10387?
A: Retirees, survivors, and participants in the State Health Benefits Program in Virginia.

Q: What is the purpose of Form A10387?
A: To enroll in the State Health Benefits Program for retirees, survivors, and participants in Virginia.

Q: What information is required on Form A10387?
A: The form requires personal information such as name, address, Social Security number, and health plan selection.

Q: Are there any deadlines for submitting Form A10387?
A: The form must be submitted within 30 days of a qualifying event or during the annual open enrollment period.

Q: Can I make changes to my health plan selection after submitting Form A10387?
A: Changes can be made during the annual open enrollment period or within 30 days of a qualifying event.

Q: Is there a cost associated with participating in the State Health Benefits Program?
A: Yes, participants are responsible for premium contributions and other applicable costs.

Q: Can I cancel my enrollment in the State Health Benefits Program?
A: Yes, participants can cancel their enrollment during the annual open enrollment period or within 30 days of a qualifying event.

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Form Details:

  • Released on March 1, 2019;
  • The latest edition provided by the Virginia Department of Human Resource Management;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form A10387 by clicking the link below or browse more documents and templates provided by the Virginia Department of Human Resource Management.

Download Form A10387 State Health Benefits Program Enrollment Form for Retirees, Survivors and Ltd Participants - Virginia

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