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This form is used to elect coverage for Long Term Care insurance provided by Unum Life Insurance Company for employees and their eligible family members. It requires personal information and beneficiaries
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How to fill out benefit election form

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How to fill out benefit election form

01
Gather necessary personal information such as your name, address, and social security number.
02
Review the different benefits offered by your employer, such as health insurance, retirement plans, and other perks.
03
Read the instructions provided with the benefit election form carefully.
04
Fill out your selections for each benefit clearly, making sure to indicate whether you want to enroll, waive, or make changes.
05
Ensure you include any required dependents' information if you are enrolling them in benefits.
06
Double-check all entries for accuracy and completeness.
07
Sign and date the form where indicated.
08
Submit the form by the deadline specified by your employer, either electronically or in hard copy.

Who needs benefit election form?

01
Employees who are eligible for company-sponsored benefits such as health insurance, retirement plans, and other employee perks.
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A benefit election form is a document that allows employees to select or change their benefits, such as health insurance, retirement plans, and other employee benefits offered by their employer.
Typically, all employees who wish to participate in their employer's benefits program during open enrollment or qualifying life events are required to file a benefit election form.
To fill out a benefit election form, employees should provide personal information such as their name and employee ID, review the available benefits, make selections for each benefit category, and sign the form to indicate their choices.
The purpose of the benefit election form is to formally document an employee's choices regarding their benefits, ensuring that the employer can provide the correct benefits as selected by the employee.
The benefit election form generally requires personal information, the chosen benefits, dependent information (if applicable), and any necessary signatures or dates.
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