coverage_center

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Welcome [Employee Name],

The following individuals are eligible to participate on the benefits below.

Above are the family members that have been previously reported by you.
If there are family members missing that you wish to enroll in any of the following coverages, you need to add them now to your eligible family member list by clicking the button above.

Instruction: Complete Balloting On All Products Below Until Each Icon Displays The Above COMPLETED BANNER

Step 2. For Each Family Member Listed Below -Select Yes To Cover or No To Waive.
Need to add a family member? See Add Household Button At Page Top.

Step 3. After Selecting Plan and Marking Each Family Member Click Save Button.

We have automatically calculated your MONTHLY PAYROLL DEDUCTION for each of the following products.

	EE Only	EE and Spouse	EE and Children	EE and Family
Short Term Disability benefit of /wk	/mo
Long Term Disability benefit of /mo	/mo
Critical 5k	/mo	/mo	/mo	/mo
Critical 10k	/mo	/mo	/mo	/mo
Critical 15k	/mo	/mo	/mo	/mo
Critical 20k	/mo	/mo	/mo	/mo
Accidental Injury Coverage	$11.92 /mo	$19.73 /mo	$23.01 /mo	$36.08 /mo

First Name*
Last Name*
Suffix
Relationship*
Date of Birth*
Gender*
Social Security No