Open Enrollment Summary
Below is a summary of your elections. Please review your elections carefully to ensure accuracy. You will also be emailed a copy of your summary.
To complete your enrollment, you must click the Acknowledge & Sign button below.As an employee, I hereby acknowledge that I understand the benefits, rights and obligations to me under these plans. I certify that the information I provided during enrollment is true and complete to the best of my knowledge. Furthermore, I agree to the below deductions and understand that I cannot make changes to these elections during the plan year unless I experience a qualifying life event.
| Product | Carrier | Plan | Coverage Level | Effective Date | Benefit Amount | Cost Per Pay |
|---|---|---|---|---|---|---|
| @[[r.product]] | @[[r.carrier]] | @[[r.plan]] |
@[[r.level]]
|
@[[r.effective_date]] | @[[r.amount || '']] | @[[r.cost]] |
| TOTAL PER PAY COST: | $57.50 | |||||
Congrats
You completed your
Newly Eligible Enrollment
You have completed the employee guided tour!