Active Employees Health Benefits Enrollment and Change Form - Maryland

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Active Employees Health Benefits Enrollment and Change Form - Maryland

Active Employees Health Benefits Enrollment and Change Form is a legal document that was released by the Maryland Department of Budget and Management - a government authority operating within Maryland.

FAQ

Q: What is the Active Employees Health Benefits Enrollment and Change Form?
A: The Active Employees Health Benefits Enrollment and Change Form is a document used by active employees in Maryland to enroll in or make changes to their health benefits.

Q: Who is eligible to use this form?
A: This form is only for active employees in Maryland who are eligible for health benefits.

Q: What can I use this form for?
A: You can use this form to enroll in health benefits, make changes to your existing health benefits, or cancel your health benefits coverage.

Q: What information do I need to provide on this form?
A: You will need to provide personal information, such as your name, employee ID, and contact information, as well as information about your dependents, if applicable.

Q: When should I submit this form?
A: You should submit this form during your employer's annual open enrollment period or within 60 days of a qualifying life event, such as getting married or having a baby.

Q: Can I make changes to my health benefits anytime?
A: No, you can only make changes to your health benefits during your employer's open enrollment period or within 60 days of a qualifying life event.

Q: What happens if I don't submit this form?
A: If you do not submit this form, you will not be enrolled in or make changes to your health benefits for the applicable period.

Q: Can I cancel my health benefits coverage?
A: Yes, you can use this form to cancel your health benefits coverage.

Q: Who should I contact if I have questions about this form?
A: If you have questions about the Active Employees Health Benefits Enrollment and Change Form, you should contact your human resources department or benefits administrator.

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Form Details:

  • The latest edition currently provided by the Maryland Department of Budget and Management;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Maryland Department of Budget and Management.

Download Active Employees Health Benefits Enrollment and Change Form - Maryland

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