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Signature Date Please complete sign and return this form no later than Tuesday May 10 2016 to Teri Taylan Benefits Manager 613 E. Broadway Room 100 Glendale CA 91206 You may also scan and email the completed form to benefits glendaleca.gov Eligibility for Temporary Transitional Subsidy of up to 300 per month from June 1 2016 through December 31 2016 and Lower Income Retiree Subsidy of up to 200 per month effective January 1 2017. City of Glendale Retiree Medical Insurance Subsidy Household...
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How to fill out retiree medical insurance subsidy

01
Gather all necessary documents such as retirement plan information, Medicare details, and any other relevant paperwork.
02
Contact your employer's human resources department to inquire about the retiree medical insurance subsidy application process.
03
Fill out the retiree medical insurance subsidy application form completely and accurately.
04
Attach copies of all required documents to the application form.
05
Submit the completed application form along with the supporting documents to the designated department or office.
06
Wait for a response from the organization handling the retiree medical insurance subsidy program.
07
Review the response and any additional instructions provided.
08
If approved, carefully review the terms and conditions of the retiree medical insurance subsidy.
09
Enroll in the designated medical insurance plan and follow any further instructions provided.
10
Keep all documents related to the retiree medical insurance subsidy for future reference and updating as required.

Who needs retiree medical insurance subsidy?

01
Retirees who are no longer eligible for employer-sponsored health insurance.
02
Retirees who do not qualify for Medicare or other public health insurance programs.
03
Retirees who need financial assistance to afford medical insurance coverage.
04
Retirees who meet the specific eligibility criteria set by their former employer or the organization providing the subsidy.
05
Retirees who want to ensure continued access to affordable healthcare options after retirement.
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Retiree medical insurance subsidy is a financial assistance provided to retirees to help cover the cost of medical insurance premiums.
Retirees who are eligible for medical insurance subsidy are required to file for it.
Retirees can fill out the retiree medical insurance subsidy form provided by their employer or insurance provider.
The purpose of retiree medical insurance subsidy is to assist retirees in paying for their medical insurance premiums.
Retirees must report their personal information, including their name, address, and insurance policy details.
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