Page History

...

• Email address:
• Telephone Number (box to the right of email):
• Work telephone (box below email):
• fax Fax Number - put "NA"

Section D: Individuals Covered

• First Box: leave as "A" Add
• Relation Code: Use drop down to select from the following:
  • EE - Employee (you will need to re-type the employee's info on this row to cover them self on this policy)
  • W = Wife
  • H = Husband
  • D = Daughter
  • S = Son
• Name - Last, First, Middle Initial 
• US Social Security Number XXX-XX-XXXX
• Birth date MM/DD/YYYY
• Skip 5 check boxes - not required
• Primary Country of Citizenship - USA 
• Residence (Indicate if same or Different than the employee (ex. children covered under plan but living in different country for school etc.. ) 
  • If different we may ask for the mailing address separately 

...