Military Reservist Active Duty Notification Sample Contracts

MILITARY RESERVIST CALLED TO ACTIVE DUTY
Military Reservist Active Duty Notification • July 16th, 2008

Health insurance Yes No Optional dental Standard life insurance Dependent life insurance Flex medical reimbursement acctFlex dependent care reimbursement acct Certification Requirements/PTSB

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MILITARY RESERVIST CALLED TO ACTIVE DUTY
Military Reservist Active Duty Notification • July 16th, 2008

If you elect to continue with your current coverage, you will be responsible to pay any premium amount over the District non-base contribution. Please complete the attached Authorization Agreement for Direct Payments and return with this form

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