This document is an employee enrollment form for UnitedHealthcare, filled out by an executive assistant hired on 08/20/2018. The form includes personal information, coverage selections, waiver of coverage for spouse, and terms and conditions for participation in the healthcare plan. The employee has declined coverage for their spouse and has selected a primary care physician and dentist. The form also includes life insurance beneficiary information and prior medical insurance details.
documents/EFTA00520760.pdf
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