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33 382. 80 HOSPITAL 579. 00 1093. 32 1531. 23 TOTAL PREMIUM 723. 75 1366. 65 1914. 03 31. 28 52. 43 83. After careful consideration I choose to either enroll or waive coverage as indicated on the benefits listed below. Furthermore I understand that my monthly cash compensation shall be reduced for the employee portion of the premium as indicated by my election and such reductions shall be made prior to calculating employment taxes. 66 62. 56 104. 86 167. 33 I AM WAIVING COVERAGE FOR THIS...
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