Benefit Premiums Agreement Sample Contracts

Gundersen Lutheran Administrative Services, Inc. – Benefit Premiums Agreement
Benefit Premiums Agreement • February 21st, 2022

The purpose of this Benefit Premiums Agreement (this “Agreement”) is to set forth the details and your obligations related to the continuation of your group health, dental, disability, life insurance, and healthcare flexible spending account coverages during your leave. You acknowledge that you have read, understand and agree to the terms set forth in this Agreement.

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