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Application for Group Supplemental Medical Reimbursement Insurance 601 Hydras Street New Orleans, LA 70130 8310 Clinton Park Drive Fort Wayne, IN 46825 Name of Group Applying: Federal ID # Address:

If spouses reside outside the United States, then the dependents must be permanent residents of the United States (i.e., U.S. citizens or U.S. National ID#'s of current lawful permanent residents). If spouses are not permanent residents and not citizens, then the plan must provide a way to determine the marital status of the spouses, but nothing is required to determine marital status if spouses reside in United Nations territories or areas with now or limited immigration controls (e.g., South Korea, New Zealand, Australia, and Canada). Coverage Limits: Coverage Amounts: If you are employed by any other health plan, your coverage limits will apply (e.g., 1,000 for self or dependent under age 26) as well as if you are covered under a group plan. (2) For persons age 26-55, in the case of certain groups, the limit is the coverage amount plus a “catch-up” benefit after age 55. For additional details, call the number provided below. This number may be changed without notice. You must contact an Insurance Agent or your group for additional information. Telephone: This number will only be reached by individuals who apply by telephone and provide appropriate identification such as a picture ID. Number Provided at Time of Application: If you have a United Nations Territory or Area without Immigration Control Number, you may dial 1-800-USA-AID for international assistance. (3) If married, the spouse coverage limit is the coverage amount plus a catch-up benefit after age 55. (4) If married and employed for less than three months, your coverage limit is 300 (or your company's contribution rate for your age). If employed for a minimum of three months or more for any employer, your employer must contribute 60% of your coverage amounts in a single contribution (this includes the portion of your coverage paid out through your group plan). If you are covered under a salary reduction program, your employer must contribute 60% of the benefits paid out by you to all persons covered by the program. If your employer is a corporation, the limit includes 50% of the minimum coverage amount plus the amount that could be contributed if covered under the group program. For additional details on limits, call the number provided at the time of application. This number may be changed without notice.

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What is benicomp login?

Benicomp login is an online platform that allows users to access their Benicomp accounts and manage their benefits and insurance policies.

Who is required to file benicomp login?

Filing benicomp login is not required. Benicomp login is merely a portal for users to access their accounts.

How to fill out benicomp login?

Benicomp login is not something that needs to be filled out. It is a login portal where users can provide their login credentials to access their accounts.

What is the purpose of benicomp login?

The purpose of benicomp login is to provide users with a secure means of accessing their Benicomp accounts online, allowing them to view and manage their benefits and insurance policies.

What information must be reported on benicomp login?

Benicomp login does not require any specific information to be reported. It is simply a means of accessing existing account information.

When is the deadline to file benicomp login in 2023?

There is no deadline to file benicomp login, as it is not a filing or reporting requirement. It is a login portal for accessing existing accounts.

What is the penalty for the late filing of benicomp login?

There are no penalties for late filing of benicomp login, as it is not a filing or reporting requirement. It is a login portal for accessing existing accounts.

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