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Insurance enrollmentchange request r0452c 2011 form

Insurance enrollmentchange request r0452c 2011 form-2025

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The document is an Insurance Enrollment/Change Request form for public school retirees in Michigan, provided by the Office of Retirement Services. It allows retirees to enroll in or change their insurance plans, update dependent coverage, and report qualifying events such as marriage or the birth of a child. The form includes sections for current insurance coverage, self and dependent data, name changes, and certification. It also outlines eligibility requirements for dependents, necessary proofs for enrollment, and conditions of enrollment.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (27 Votes)
2015	4.3 Satisfied (43 Votes)
2011	4 Satisfied (30 Votes)

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