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When would be the employee s next opportunity to enroll i.e. when is your company s open enrollment Please explain reason for ineligibility. There will be no reimbursements for charges already assessed. For assistance please contact the ESconnection 866 275 3737 or ESconnection qg. Employee Signature Date MM DD YY Required 10/14/2016 EMPLOYER VERIFICATION TO BE COMPLETED BY THE SPOUSE S EMPLOYER ONLY Your employee is enrolled in Quad/Graphics medical plan under his/her spouse....

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8662753737 is the form number for reporting certain information to the IRS.

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