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Paper Employee Notices.pdf

Important-Notices_Paper-Employee-Benefit-Notices.pdf

🔗 Source: osdbenefits.com

📊 Size: 87 KB

👤 Author: kayla.gloege

⬇️ Downloads: 175

Summary

Please return to Human Resources within 30 days of receipt. This acknowledgement applies to those who requested paper copies of the Employee Benefit Notices. I, hereby confirm, I have received the following Employee Benefit Notices at [location]. These include: Summary of Benefits and Coverage (SBC), Children's Health Insurance Program (CHIP), Women's Health and Cancer Rights Act (WHCRA) of 1998, Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986, Special Enrollment Notice, New Health Insurance Marketplace Coverage Options Notice, Health Insurance Portability and Accountability Act (HIPAA) of 1996, The Genetic Information Nondiscrimination Act (GINA) brochure, Newborns’ and Mothers’ Health Protection Act Notice, Summary Plan Description (SPD), Plan Amendments, Summary of Material Modification (SMM), Summary of Material Reduction (SMR). My signature below serves as a valid acknowledgement of the provided Employee Benefit Notices. Name (Please Print) Employee ID Date Signature Email address Please forward form to Human Resources.

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Description

Please return to Human Resources within 30 days of receipt. This acknowledgement applies to those who requested paper copies of the Employee Benefit Notices.

Technical Information

File Format: PDF
File Size: 87 KB
Pages: 1
Language: EN
Author: kayla.gloege
Total Downloads: 175
Last Updated: 2 weeks ago

Document Overview

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