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CHANGE OF BENEFIT ELECTION OR DROP FORM Please cancel my previously authorized salary reduction(s) as follows: Amount per Pay Period Company $ $ $ Product CHECK ONE **125 Plan or After tax Please
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How to fill out change of benefit election

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How to Fill Out Change of Benefit Election:

01
Obtain the necessary forms: Contact your employer or benefits administrator to request the change of benefit election forms. They may be available online or in hard copy.
02
Review the instructions: Read through the instructions provided with the forms to understand the process and any specific requirements or deadlines.
03
Provide personal information: Fill out the required personal information section of the form, such as your full name, employee identification number, contact details, and other relevant details.
04
Select the desired benefits: Indicate which benefits you wish to change or elect by checking the appropriate boxes or providing the necessary details. Examples of benefits could include health insurance, retirement plans, life insurance, or flexible spending accounts.
05
Specify effective dates: If applicable, state the effective date for your requested changes. This could include the date you want the new benefits to begin or when you wish to cancel previous benefits.
06
Provide supporting documentation: If required, attach any necessary supporting documentation, such as marriage certificates, birth certificates, or medical documentation, to validate your requested changes.
07
Signature and date: Sign and date the form to confirm that the information provided is accurate and that you understand the consequences of your requested changes.
08
Submit the form: Follow the instructions provided on how to submit the completed form. This may involve mailing it to a specific address or submitting it electronically through an online portal.
09
Keep a copy for your records: Before submitting the form, make a copy for your personal records. This ensures that you have a copy of the completed form, including any supporting documentation.
10
Follow up: If necessary, follow up with your employer or benefits administrator to ensure that your change of benefit election has been processed correctly and to address any questions or concerns that may arise.

Who needs a change of benefit election?

01
Employees undergoing significant life changes: Individuals who experience events such as marriage, divorce, birth or adoption of a child, or the death of a spouse, may need to make changes to their benefit elections to accommodate these life changes.
02
Employees with changing needs: As personal circumstances change, an employee's benefit needs may also change. For example, if an individual's health condition changes, they may need to adjust their health insurance coverage or add additional benefits such as disability insurance.
03
Open enrollment periods: Some employers have designated open enrollment periods during which employees can make changes to their benefit elections. Even if an employee's personal circumstances have not changed, they may still need to review and update their benefit elections during these specified periods.
Note: It is important to consult with your employer or benefits administrator for specific guidelines and requirements regarding the change of benefit election process at your organization.
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