Please click to review your worksheet and determine if you’d like to make any changes for your benefit plan becoming effective April 1, 2021. If you’d like to change something, please select from the links below to download the appropriate form. Once completed, signed and dated, scan and EMAIL BACK TO ME. If you do not want to make any changes, we MUST hear from you via email saying your name and No Changes. Of course, if you have any questions, please call or email me. Gary Kynard firstname.lastname@example.org or (213) 479-5503 cell. All forms and emails should be received no later than Friday, March 19, 2021.
CLICK THIS LINK FOR YOUR WORKSHEET
Click Here for Choice Builder Worksheet
Election To Participate Form
Calchoice Employee Application
Calchoice Waiver Of Coverage Form
Choice Builder Employee Application
Choice Builder Waiver Of Coverage Form