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Please see instructions. If you elect an HMO plan you must provide the PMG/IPA of the physician or medical group you are electing to enroll in. Tier Single Employee One Spouse or Child Plan Name Individual/Family Deductible s Co-Insurance Maximum Hosp Surg X-Ray and Lab Doctor Visits Other Professional Out-of-Network Payment Prescription Drug Co-pay Anthem Classic PPO 20 40055C 300/ 600 1 000/ 3 000 20 co-pay Non-Participating Fee Nativus Retail up to 30-day 7 generic/ 25 Brand Mail Order up...
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How to fill out classified plan election form
How to fill out classified plan election form
01
Read the instructions for filling out the classified plan election form.
02
Collect all the necessary information and documents needed for the form.
03
Start by writing your personal details such as name, address, and contact information.
04
Specify the election you are participating in and the position you are running for, if applicable.
05
Provide any additional information required, such as previous experience or qualifications.
06
Double-check that all the information provided is accurate and complete.
07
Sign and date the form.
08
Submit the filled-out form to the appropriate election authority.
09
Keep a copy of the form for your records.
Who needs classified plan election form?
01
Candidates running for a political position in an election.
02
Individuals seeking to participate in classified elections.
03
People who want to exercise their right to vote in classified plan elections.
04
Political parties or organizations organizing classified plan elections.
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