Enrollment Wizard

Welcome, Tom A. Adams

Enrollment Summary

Steps
	1.	Instructions
	2.	Personal Information
	3.	Dependents
	4.	Confirm Information
	5.	Medical Benefits
	6.	Dental Benefits
	7.	Vision Benefits
	8.	Disability Benefits
	9.	Life & Accident Benefits
	10.	FSA Benefits
	11.	Other Benefits
	12.	Beneficiary Information
	13.	Confirm and Submit

VIEW CURRENT BENEFITS SUMMARY

Confirm Information

Step 4 of 13

Before continuing, please review the following information carefully to ensure that it is correct and complete.

Once you click Continue on this page, you will not be able to go back through the previous steps to make changes or additions. If later on you discover you have made a mistake, please contact your HR Department as soon as possible.

Tom A. Adams
118 Apple Lane
Detroit, MI 80138

Social Security Number:	435-444-2011
Date of Birth:	12/18/1960

Gender:	Male
Marital Status:	Married
Smoker:	No

Dependents:	Jane C. Adams	(Spouse)
	Jill A. Adams	(Child)
	Ralph A. Adams	(Child)
	Penelope Adams	(Child)

Home Phone:	(313) 989-9980
Cellular Phone:	(313) 880-8787
E-mail:	employee@domain.com
Pager:	(313) 777-3938
Emergency Contact
Name:	James Smith
Relationship:	Spouse
Phone Number:	(313) 989-9980