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Get GIC DENTAL/VISION ENROLLMENT/CHANGE FORM

Derstand that my coverage elections are binding for the duration of the plan year and that I may only enroll in coverage during the plan year if I experience a qualifying status change, (examples include marriage, adoption/birth of a child, divorce, death of a dependent, and involuntary loss of coverage). I understand that the GIC must receive any required documentation within 60 days of the event. Signature of Applicant:.

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