Non-Represented and Eligible Represented Employees - ucm mtabsc 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section 2 - Employee Information. Enter your full name, BSC ID, agency/department, contact details, and address accurately.
3. Move to Section 3 – Incentive Selection. Carefully read each option regarding your medical coverage status and initial your selection to confirm your choice.
4. In Section 4 – Medical Coverage Information, provide the necessary details about your insurance plan including the name of the insurance company and policyholder.
5. Review Section 5 for understanding the terms of your election. Ensure you sign and date the form at the bottom before submission.
6. Once completed, save your document and send a signed copy via fax or email as instructed.

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