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NEGATIVE OR “DEFAULT” ELECTIONS

Employees who do not want to enroll in company-sponsored health or benefits packages must opt out in writing in order to not participate in the plan.

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Create Account: Step 1 of 3

First Name

First name is required

Last Name

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Email Address

Email address is required

Agency Name / Organization

Agency Name / Organization is required

Your Job Title

Your Job Title is required

State

State is required

# of Employees

# of Employees is required

Phone Number X (XXX) XXX-XXXX

Phone Number is required

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