Transcript
Medical Plan A Medical Plan B Medical HDHP Dental
After a complete explanation of the health plan, and after careful consideration, I am waiving ALL benefit coverage for: (Check all that apply)
(Complete Sections A, B, D, E)
Medical Plan A Medical Plan B Medical HDHP Dental
After a complete explanation of the health plan, and after careful consideration, I am waiving ALL benefit coverage for: (Check all that apply)
(Complete Sections A, B, D, E)
