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Group Employee Enrollment and Change Form: This form only applies to full-time employees. This is the application for the employee’s term life, long-term disability, medical, and dental insurance plans. The employee completes sections A, B, C, E, and F of this form; section D is completed by the Office of Parish Administration. If the employee is waiving medical and/or dental insurance, this should be indicated in section C. This form must be returned to the Office of Parish Administration within 30 days of the employee’s start date or there may be problems with the employee’s insurance, and the parish could face significant financial liability because of this. Contact the Office of Parish Administration to get this form.
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