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Enrollment Effective Date:
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09/13/2001
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Coverage:
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Family
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Employee PCP ID:
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MD34353
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Current Patient: Yes
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Dependents:
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PCP ID
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Current Patient
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Jane C. Adams
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(Spouse)
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OKS2141
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Yes
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Jill A. Adams
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(Child)
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OKS2141
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Yes
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Ralph A. Adams
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(Child)
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OKS2141
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Yes
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Penelope Adams
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(Child)
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OKS2141
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Yes
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Cost:
(per pay period)
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Employee Cost
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$162.63
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Company Cost
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$91.23
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Note: Place cost note here.
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Please make sure that your list of dependents to be covered matches your
chosen coverage.
If you would like to make changes to your enrollment in this plan, click Back. |
