Common Contracts

1 similar Flexible Benefit Plan Election Form contracts

TOWN OF RIVERHEAD FLEXIBLE BENEFIT PLAN
Flexible Benefit Plan Election Form • November 27th, 2012

Prior to the first day of each plan year I will be required to complete a new Benefit Election Form. My election is effective for the plan year and may be changed during the year only for changes in family status (e.g., marriage or divorce, death of spouse or dependent, adoption or birth of child, certain changes in spouse's employment that affect health coverage).

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