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FOR INTERNAL USE ONLY HIS HISSED#: ID# EC: EC78124NY090000300 IJJKIndividual & Family Health Insurance Application/Change Form Please print clearly and complete all sections that apply to you Additional

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How to fill out section 1 plan options

01

To fill out section 1 plan options, follow these steps:

02

Start by reading the instructions carefully.

03

Review the available plan options and understand the details of each one.

04

Consider your healthcare needs and preferences to determine the most suitable plan option for you.

05

Once you have decided on a plan option, fill in the corresponding bubble or box on the form.

06

Double-check your selection to ensure accuracy.

07

If you have any questions or need assistance, consult the provided helpline or contact a healthcare professional.

08

Complete any additional required information in section 1 regarding personal details or other relevant factors.

09

Finally, review the filled-out form to verify that all information is correct before submitting it.

Who needs section 1 plan options?

01

Section 1 plan options are needed by individuals who are enrolling in a healthcare plan or making changes to their existing plan. This includes anyone who wants to ensure coverage for medical expenses and access to specific healthcare services. Employers may also require employees to fill out section 1 plan options as part of their benefits enrollment process.

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