29.10.2014 Views

12th Annual Federal Workers' Compensation Conference S i #39 ...

12th Annual Federal Workers' Compensation Conference S i #39 ...

12th Annual Federal Workers' Compensation Conference S i #39 ...

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

Agency Information &<br />

Certification<br />

• <strong>Federal</strong> Employees<br />

• Enrolled?<br />

Health Benefit & • Enrollment code?<br />

Group Life<br />

• Surviving Spouse<br />

Insurance<br />

eligible for<br />

Information<br />

benefits?<br />

• FEGLI coverage?<br />

• Options of<br />

Coverage (Option<br />

A, B, C or No<br />

optional coverage)<br />

41

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!