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Employee Request To Participate In Medical Plan Templates Free Download

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Below is the Employee Request To Participate In Medical Plantemplate body. If necessary, please put the personal information, company information, such as text to replace the specific content you need. you can download the .doc template file on the end of the article by click download link.



March 11, 2014


Contact Name
Address
Address2  
City, State/Province
Zip/Postal Code



OBJECT: AUTHORIZATION TO PARTICIPATE IN MEDICAL PLAN

To Whom It May Concern:

As an employee of [NAME OF FIRM], I do [DO/NOT] wish to participate in the Company's Medical Plan.

[NAME OF FIRM] is hereby authorized to make the necessary deductions from my earnings or any disability benefit paid to me by the company, for the amount specified in the Group Insurance Schedule.

It is my understanding that I will be eligible to participate in the Company Medical Plan as of [DATE] and that the monthly deductions referred to herein will begin on [DATE].

I further understand that the acceptance of my application for participation in the Company Medical Plan is contingent upon my ability to meet the medical requirements determined by [NAME OF INSURANCE COMPANY].





          
Signature


          
Employee Name - Print Letters




click to download Employee Request To Participate In Medical Plan template

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