Enrollment and Change Form - Utah

Enrollment and Change Form - Utah

Enrollment and Change Form is a legal document that was released by the Utah Department of Human Resource Management - a government authority operating within Utah.

FAQ

Q: What is the purpose of the Enrollment and Change Form?
A: The Enrollment and Change Form is used to enroll or make changes to your benefits coverage in Utah.

Q: Who can use the Enrollment and Change Form?
A: Employees and eligible dependents in Utah can use the Enrollment and Change Form to enroll or make changes to their benefits coverage.

Q: What changes can be made using the Enrollment and Change Form?
A: Using the form, you can make changes to your benefits coverage, such as adding or removing dependents, changing your healthcare plan, or updating your contact information.

Q: Is there a deadline for submitting the Enrollment and Change Form?
A: Yes, there is usually a deadline for submitting the Enrollment and Change Form. Check with your employer or the Utah benefits program for the specific deadline.

Q: What should I do if I have questions about the Enrollment and Change Form?
A: If you have questions about the Enrollment and Change Form, you should reach out to your employer's HR department or the Utah benefits program for assistance.

Q: Can I make changes to my benefits coverage outside of the enrollment period?
A: In general, changes to benefits coverage can only be made during the open enrollment period, unless you experience a qualifying life event. Check with your employer or the Utah benefits program for specific rules.

Q: What happens after I submit the Enrollment and Change Form?
A: After you submit the Enrollment and Change Form, your request will be processed, and you will receive confirmation of any changes made to your benefits coverage.

Q: How often do I need to submit the Enrollment and Change Form?
A: You typically need to submit the Enrollment and Change Form annually during the open enrollment period. However, you may need to submit it sooner if you experience a qualifying life event.

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Form Details:

  • Released on December 13, 2019;
  • The latest edition currently provided by the Utah Department of Human Resource Management;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Utah Department of Human Resource Management.

Download Enrollment and Change Form - Utah

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