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Healthcare Election Form FULL TIME TEMPORARY EXEMPT EMPLOYEES CHICAGO TRANSIT AUTHORITY Fax Form To (312) 2758722 or Mail Form check all that apply HR Benefit Services 567 W. Lake Street, Chicago,

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How to fill out health and dental enrollment

01

Obtain the health and dental enrollment forms from your employer or insurance provider.

02

Fill in your personal information, including your name, address, and contact details.

03

Provide information about your dependents, if applicable.

04

Select the health plan and dental coverage options that best suit your needs.

05

Review the enrollment form for accuracy and completeness before submitting.

Who needs health and dental enrollment?

01

Employees who are eligible for health and dental benefits through their employer.

02

Individuals who are self-employed and need to purchase health and dental insurance on their own.

03

Families looking to enroll their dependents in a health and dental plan.

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What is health and dental enrollment?

Health and dental enrollment is the process through which individuals or families sign up for health and dental insurance coverage, ensuring they have access to medical and dental services.

Who is required to file health and dental enrollment?

Individuals and families who wish to have health and dental insurance coverage are required to file health and dental enrollment. This typically includes employees who wish to enroll in employer-sponsored plans as well as individuals seeking to enroll in marketplace options.

How to fill out health and dental enrollment?

To fill out health and dental enrollment, individuals need to complete a form that usually requires personal information, details of dependents, and specific coverage options they wish to enroll in. This can often be done online or through managed care organizations.

What is the purpose of health and dental enrollment?

The purpose of health and dental enrollment is to ensure individuals and families have proper insurance coverage for their medical and dental needs, providing financial protection against healthcare costs.

What information must be reported on health and dental enrollment?

The information that must be reported includes personal identification details, demographic information, household income, the number of dependents, and any existing health conditions that may be relevant for enrollment purposes.

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