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Submit Life Event
Benefits > Blue Care Network HMO > Edit Enrollment
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Please confirm the following information:
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Change Effective Date: 09/13/2001
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Coverage:
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Family
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Dependents:
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Jane C. Adams
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(Spouse)
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Jill A. Adams
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(Child)
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Ralph A. Adams
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(Child)
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Penelope Adams
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(Child)
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Cost:
(per pay period)
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Employee Cost
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$253.86
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Company Cost
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$0.00
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Please verify that the dependent information is correct. Selected dependent(s) should match chosen coverage.
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