Enrollment Completed! Action Required (see below)

Action Required (see below)

Confirmation number	14252120616
Submitted	at 2:03pm ET

Monthly Cost

$297.34

You can make changes to this event until Nov 30, 2019 at 11:59pm ET.

A record of this transaction will be saved in transaction history.

Action Required

Complete your Evidence of Insurability (EOI) Online - you have 30 days to complete your EOI for Employee Supplemental Life Insurance. Until your provider approves your completed EOI, you will remain enrolled in 3x Pay coverage at a cost of $10.50 per pay period.
Verify your family members - because you have added a family member(s) to benefits coverage, you must provide proof of their eligibility for benefits. Failure to provide the requested materials by the deadline will result in their loss of coverage.
Make a COBRA payment - because you have enrolled in COBRA benefits coverage, you must provide payment. Failure to provide payment by the deadline will result in a loss of coverage.

Next Steps – now that you are done with your event, here are a few things to consider:

	Monthly Cost	You	Pat	Morgan	Cameron
Retiree Pre-Medicare Medical Consumer Choice HDHP (HSA Eligible)	$271.84 01/01/
Retiree Medicare Medical Core Senior Advantage	N/A 01/01/
Supplemental Medical Supplemental Medical Plan	N/A 01/01/
Retiree Medical HRA Coverage	N/A 01/01/
Retiree Dental Comprehensive Dental Plan	$20.00 01/01/
Retiree Life Insurance 2 x Base Pay, $250,000	$5.50 01/01/
Total	$297.34