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ENROLLMENT, CHANGE, CANCELLATION, OR OPT OUT EMPLOYEES Polyfill in all pertinent information. Send this form to the LENS Benefits Office by email: llnlbenefits LLN.gov or Lab Mail: L640HEALTH AND

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UC retirees who worked refers to individuals who have retired from the University of California system and are engaged in employment after their retirement.

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Any retired employee of the University of California system who has resumed employment must file reports regarding their work and income.

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