Current Location: | Home > Interactive Demonstration > Employer Connection > The NEW Online Enrollment > Online Enrollment Group Change |
April 28, 2024
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Name | Relationship | Date of Birth | Effective Date | Termination Date |
---|---|---|---|---|
STONE, KERWIN J | Employee | 02/17/1975 | 02/01/2007 | |
STONE, CHARLENE J | Spouse | 02/17/1975 | 02/01/2007 | |
STONE, LINUS L | Child | 05/21/1983 | 02/01/2007 |
Select | Name | Relationship | Date of Birth | Effective Date | Termination Date |
---|---|---|---|---|---|
STONE, KERWIN J | Employee | 02/17/1975 | 02/01/2007 | ||
STONE, CHARLENE J | Spouse | 02/17/1975 | 02/01/2007 | ||
STONE, LINUS L | Child | 05/21/1983 | 02/01/2007 |
Current Group: | 20883-000-00000-28011 FULLY INSURED |
Enter the New Group Number: | |
Enter the Effective Date of the Group Change: | Format: MM/DD/YYYY |
Hire Date: | Format: MM/DD/YYYY |
ENR0007-Eff Date Does not Equal Waiting Period. Enter a Qualifying Event Code. |
Qualifying Event: |