Bright Sky Group of Services

Employee Medical Coverage Elections 2021


EMPLOYEE DECLINES OR ACCEPTS MEDICAL COVERAGE:

 

Your selected coverage:  

Your plan selection:  

 

Sign below to confirm your rejection or acceptance of medical coverage. If accepting medical coverage, by signing below I give authority for National Star Services to deduct the amount above from my paycheck.

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Signature Certificate
Document name: Employee Medical Coverage Elections 2021
lock iconUnique Document ID: 9861d633fa3c605c39eb6c36f79eafec195d99b9
Timestamp Audit
January 17, 2021 10:32 pm CSTEmployee Medical Coverage Elections 2021 Uploaded by National Star Services - noreply@brightskyinc.com IP 68.98.116.57