FW: Election Summary 2019

[http://dummy.us.eu.org/robert (Robert)]

Here's what I ended up signing up for.

Content-Type: application/pdf;  name="BenefitsOpenEnrollmentStatement2019.pdf"
Content-Description: BenefitsOpenEnrollmentStatement2019.pdf
Content-Disposition: attachment;  filename="BenefitsOpenEnrollmentStatement2019.pdf"; size=30951;  creation-date="Tue, 20 Nov 2018 21:09:24 GMT";  modification-date="Tue, 20 Nov 2018 21:09:24 GMT"
Content-Transfer-Encoding: base64

Robert (Election Summary)

https://www.eenroller.net/btrac/�exreport.asp?P...

Election Summary
Employee:, Robert
Address: 
where-I-live 

Plan Elections Amounts shown are per (Bi-W
Bene�t Plan Coverage Category Description
Cigna PPO Medical Employee + Spouse $800 Plan
Health Savings Account Declined Declined
HSA CatchUp Declined Declined
MetLife Dental Plan Dental PPO Employee + Spouse
VSP Vision Plan Vision Employee + Spouse

https://www.eenroller.net/btrac/�exreport.asp?P...

Health Care FSA Navia Health $1,359.80 deferral (A
Dependent Care FSA Declined Declined
MetLife Voluntary Life/AD&D Plan Employee Employee $500,000.00
Voluntary Life/AD&D Spouse Declined Declined
Voluntary Child Life/AD&D Declined Declined
MetLife Short Term Disability $1,924.00 (Weekly)
MetLife Long Term Disability $7,502.40 (Monthly)
MetLife Life/AD&D Basic Plan $151,000.00

Robert (Election Summary)

https://www.eenroller.net/btrac/�exreport.asp?P...

Summation Amounts shown are per (Bi-Week
Total out of pocket expense: $366.70
Family Members
Name Relation
Noelle Spouse

Primary Bene�ciaries
Bene�t
Voluntary Employee Life/AD&D

Name
Noelle

Contingent Bene�ciaries
Bene�t
Name
Relationship
There are no Contingent Bene�ciaries

The above re�ects bene�ts that I have elected a
employer to make the necessary payroll deducti
to my elected bene�ts, or enroll
in1:09any

Robert (Election Summary)

https://www.eenroller.net/btrac/�exreport.asp?P...

bene�ts until the next open enrollment period, e
Status Changes". Pursuant to IRS Section 125 ru
writing of a "Quali�ed Family Status Change" w
occurrence.

11/20/18, 1:09 PM