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BENEFIT ELECTION / PREMIUM CONFIRMATION FORM Rates are valid for Fiscal Year July 1, 2021, through June 30, 2022, FULL NAME: First, MI, Last (please print):Last 4 digits of SSN:Address:Date of Birth://THE

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How to fill out benefit election premium confirmation

01

Log in to the benefits portal using your credentials

02

Navigate to the section for benefit elections

03

Select the option for premium confirmation

04

Verify the details of your current benefit elections

05

Make any necessary updates or corrections

06

Review the premium amounts and confirm your selections

07

Save or submit your changes as required

Who needs benefit election premium confirmation?

01

Employees who have selected and enrolled in benefit options through their employer

02

Individuals who want to confirm their chosen benefit premiums

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What is benefit election premium confirmation?

Benefit election premium confirmation is a form that confirms the benefits selected by an individual and the premiums associated with those benefits.

Who is required to file benefit election premium confirmation?

Employees or individuals who have selected benefits through their employer's benefits program are required to file benefit election premium confirmation.

How to fill out benefit election premium confirmation?

Benefit election premium confirmation can be filled out by providing accurate information about the selected benefits, such as health insurance, dental insurance, and vision insurance, along with the corresponding premiums.

What is the purpose of benefit election premium confirmation?

The purpose of benefit election premium confirmation is to verify the benefits selected by an individual and the associated premiums to ensure accuracy in benefit enrollment.

What information must be reported on benefit election premium confirmation?

Information such as the benefits selected (health, dental, vision), corresponding premiums, coverage start date, and any dependent information must be reported on benefit election premium confirmation.

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