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ELK GROVE BENEFITS EMPLOYEE RETIREMENT TRUST Participation Agreement for Retiree Medical Benefits This Agreement is entered into between (Retiree) and, if applicable, Retirees spouse (Spouse) and
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01
Obtain the elk grove benefits employee form from your employer or human resources department.
02
Read the instructions carefully to understand the information that needs to be provided.
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Start by filling out your personal details such as your full name, address, contact information, and employee identification number.
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Next, provide information about your dependents, if applicable, including their names and relationship to you.
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Proceed to fill out the sections related to the specific benefits you wish to enroll in, such as health insurance, retirement plans, or flexible spending accounts.
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Pay close attention to any additional documents or supporting information that may be required, such as proof of dependent eligibility or medical history forms.
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Double-check all the information you have provided to ensure accuracy and completeness.
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Sign and date the form in the designated areas.
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Submit the completed form to the appropriate department or individual within your organization.
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Any employee who wishes to enroll in or make changes to their existing benefit plans provided by their employer.
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