Employee Request to Participate in Medical Plan Template

This employee request to participate in medical plan template has 1 pages and is a MS Word file type listed under our human resources documents.

Sample of our employee request to participate in medical plan template:

OBJECT: AUTHORIZATION TO PARTICIPATE IN MEDICAL PLAN To Whom It May Concern: As an employee of [NAME OF FIRM], I do [DO/NOT] wish to participate in the Company's Medical Plan. [NAME OF FIRM] is hereby authorized to make the necessary deductions from my earnings or any disability benefit paid to me by the company, for the amount specified in the Group Insurance Schedule. It is my understanding that I will be eligible to participate in the Company Medical Plan as of [DATE] and that the monthly deductions referred to herein will be