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Within 60 days of a documented qualifying status change. Health benefits enrollment form enrolling in a health prescription plan there are two areas labeled health insurance plans on page one of the health benefits enrollment form. Complete the enrollment form for the new hire process elect or decline medical coverage on the enrollment form you must sign and date the bottom of the form even if you decline coverage return the enrollment form. If you are changing your phip coverage a phip disenrollment form must also be submitted in order to term the original plan s.
I also certify that i have read and understand the provisions of the medical plans as detailed in the sdcera.
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