Get Nj Hd-0719 2020-2026

Filling out the New Jersey HD-0719 form, also known as the Employee Dental Enrollment and/or Change Form, is a crucial step for active employees seeking to manage their dental benefits. This guide provides clear instructions to assist users in successfully completing this form online, ensuring all necessary information is accurately provided.

Follow the steps to complete the NJ HD-0719 online.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. In Section 1, fill out the member information. Include your last name, first name, middle initial, gender, birth date, social security number, marital status, phone number, and email address.
3. In Section 2, indicate the reason for your application by checking one box. Options include New Enrollment, Transfer, Open Enrollment, Loss of Coverage, Adding Dependents, Deleting Dependents, Waiver of Coverage, or Other. Be sure to provide the date of the event if applicable.
4. In Section 3, select the level of coverage you wish to enroll in. Choose from options including Single, Parent/Child(ren), Member/Spouse/Civil Union, Member/Domestic Partner, or Family.
5. In Section 4, select a dental plan from the available options. Remember that you must remain enrolled in your chosen plan for 12 months.
6. In Section 5, provide information about all eligible dependents. List their names, social security numbers, relationships to you, birth dates, and genders. Attach any necessary proof of dependency documentation.
7. In Section 6, review the member certification statement, then sign and date the form to certify that the information is accurate. Make sure to attach any required dependent documentation.
8. Finally, save your changes, and depending on your needs, download, print, or share the completed form as required. Remember to submit it to your employer's human resources office for certification.

Complete your NJ HD-0719 application online today to ensure your health benefits are properly managed.