Common Contracts
2 similar Stepchild Dependency Agreement contracts
Stepchild Dependency AgreementStepchild Dependency Agreement • July 22nd, 2016
Attach this completed and signed form to your completed Highmark Enrollment/Change form and United Concordia Enrollment forms. These forms are available on the CLIU website under Departments/Human Resources/Benefits Blueprints. All forms must be received by the Benefits Specialist within 30 calendar days after the qualifying event.
Stepchild Dependency AgreementStepchild Dependency Agreement • April 15th, 2014
Attach this completed and signed form to your completed Highmark Enrollment/Change form and United Concordia Enrollment forms. These forms are available on the CLIU website under Departments/Human Resources/Benefits Blueprints. All forms must be received by the Benefits Specialist within 30 calendar days after the qualifying event.
