Required for subscribers enrolling in a Dependent Care FSA. eligibility for your group. This document explains the data requirements for the spreadsheet. When you load the …

Instead of each enrolling Employee submitting an enrollment application, the required enrollment data is entered into an Excel template provided by Regence or downloaded into a spreadsheet …

Employee Enrollment/Change form. 2. If you are enrolling a dependent who is a non-qualified tax dependent, you must also complete a PEBB Declaration of Tax Status form. 4. Submitting the …

This field is required on the employee and spouse row if the group has LESS THAN 20 lives AND the employee is enrolling in Supplemental Dependent Spouse Life/AD&D. Otherwise, leave …

LMSW Are you enrolling using a LMSW or LBSW license? LBSW Are you enrolling using an LPCC or LMHC/LPC license? * Copy of Renal Dialysis facility License * Copy of Medicare …

6 36 Enrollment Date Options: Once you are accepted into the MHA program, you can begin enrolling in classes! There are EIGHT (8 potential starting month options to choose from.

Employee Enrollment/Change form if enrolling a state-registered domestic partner, a state-registered domestic partner's child, or other dependent that does not qualify as a dependent …