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PLAN ELECTION FORM Period of January 1, 2020, December 31, 2020, Check the box below that indicates your choice of health coverage. Sign and date this form and return to the benefit administrator.

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3. Begin filling out the form or application by providing accurate and complete information. Double-check all entries for errors before moving to the next section.
4. Use clear and legible handwriting if filling out a paper form. If completing an online form, type in the required fields.
5. Be mindful of any specific formats or conventions for providing dates, phone numbers, addresses, and other details.
6. Check whether any sections require additional explanations or attachments, and provide them as necessary.
7. Review the completed form or application to ensure all necessary fields are filled and all required documents are attached.
8. Sign and date the form or application as instructed. If submitting online, follow the provided guidelines for electronic signatures.
9. Make copies of the completed form or application and any supporting documents for your records.
10. Submit the form or application through the designated method, such as mailing it, submitting it online, or delivering it in person.
11. Keep track of any confirmation numbers or receipts for future reference or follow-up.
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Forms and applications refer to the official documents required for various administrative processes, including tax filings, business registrations, or any other compliance-related procedures.

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