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University of North Alabama GROUP HEALTH ENROLLMENT/CHANGE FORM OPEN ENROLLMENT 2019 EMPLOYEE INFORMATION EMPLOYEE NAME: Last Name, First Name, GENDER: Female Teletype OF MEDICAL COVERAGE SELECTED:
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What is group health enrollmentchange form?
The group health enrollmentchange form is a document used to make changes to a group health insurance plan for members.
Who is required to file group health enrollmentchange form?
Employers or plan administrators are required to file the group health enrollmentchange form.
How to fill out group health enrollmentchange form?
The form can be filled out online or by hand, providing specific details about the changes being made to the group health plan.
What is the purpose of group health enrollmentchange form?
The purpose of the form is to ensure accurate and up-to-date information about the group health insurance plan and its members.
What information must be reported on group health enrollmentchange form?
Details such as member names, coverage options, effective dates, and any other relevant information regarding the changes made to the group health plan.
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