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Get The Purpose Of This Form Is To Determine If The Spouse/domestic ...

E covered by the College s health care plan. If a spouse/domestic partner of a BW employee has access to any employer-sponsored health care plan*, or to any employer-sponsored retiree or disability health care plan*, effective January 1, 2010, s/he is not eligible to be covered under any Baldwin-Wallace College health care plan. This form is to be completed by the employee. Employee Name (Please Print): Name of Spouse/Domestic Partner (Pleas.

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