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Print Health Benefits Election Form Approved: OMB No. 3206-0160 Federal Employees Health Benefits Program Complete Parts A and G, and Parts B, C, D, E, and F as applicable. For Employees, Former Spouses
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What is health benefits election form?
The health benefits election form is a document that allows individuals to choose their health insurance coverage and benefits.
Who is required to file health benefits election form?
Employees who are eligible for health insurance benefits provided by their employer are required to file the health benefits election form.
How to fill out health benefits election form?
To fill out the health benefits election form, individuals need to provide their personal information, select their desired health insurance plan, and indicate any additional coverage or benefits they wish to enroll in.
What is the purpose of health benefits election form?
The purpose of the health benefits election form is to allow individuals to make informed choices about their health insurance coverage and benefits.
What information must be reported on health benefits election form?
The health benefits election form requires individuals to report their personal information such as name, address, and social security number. They also need to provide details about their desired health insurance plan, any additional coverage options, and dependent information if applicable.
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