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Health Care Benefits Election Form Local 77 New Employee Enrollment orReenrolling After Waiving/Declining Coverage Last Name (Please Print) First NameEmployee NumberDepartment Home Address Streetcar
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Re-enrolling after waiving or declining coverage refers to the process where individuals who previously opted out of a health insurance plan can choose to enroll again, typically during an open enrollment period or qualifying event.
Individuals who previously waived or declined coverage but wish to enroll again are required to file for re-enrollment. This may include employees, dependents, or anyone eligible who had previously chosen not to participate.
To fill out re-enrollment after waiving or declining coverage, individuals need to complete the designated enrollment form provided by their employer or insurance provider, ensuring to include all required personal and health information, along with any necessary documentation.
The purpose of re-enrolling after waiving or declining coverage is to allow individuals access to health insurance benefits they may need, especially after experiencing changes in circumstances, such as a new job, family addition, or health changes.
The information that must be reported on re-enrolling includes personal identification details, contact information, any changes in health status, dependent information, and selected coverage options.
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