Get the free Premium Conversion Enrollment Form for Lees-McRae College - lmc

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Premium Conversion Enrollment Form for LeesMcRae College Effective January 1, 2016, Name Address Social Security # This authorizes the payroll department to reduce my salary by the amount(s) necessary

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What is premium conversion enrollment form?

The premium conversion enrollment form is a document that allows employees to elect to pay their portion of health insurance premiums on a pre-tax basis.

Who is required to file premium conversion enrollment form?

Employees who wish to have their health insurance premiums deducted from their pre-tax income are required to file the premium conversion enrollment form.

How to fill out premium conversion enrollment form?

Employees can fill out the premium conversion enrollment form by providing their personal information, selecting their coverage options, and signing the form.

What is the purpose of premium conversion enrollment form?

The purpose of the premium conversion enrollment form is to give employees the option to pay for health insurance premiums on a pre-tax basis, which can result in tax savings.

What information must be reported on premium conversion enrollment form?

The premium conversion enrollment form typically requires personal information such as name, address, social security number, as well as selected coverage options and signature.

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