Interactive Demonstration - Enrollment Maintenance

February 4, 2012

Select Member
Name	Relationship	Date of Birth	Effective Date
STONE, KERWIN J	Employee	02/17/1975	02/01/2007
STONE, CHARLENE J	Spouse	02/17/1975	02/01/2007
STONE, LINUS L	Child	05/21/1983	02/01/2007

For individual updates, click the specific dependent you wish to maintain.

Select/Deselect All

Modify Group
Name	Relationship	Date of Birth	Effective Date
STONE, KERWIN J	Employee	02/17/1975	02/01/2007
STONE, CHARLENE J	Spouse	02/17/1975	02/01/2007
STONE, LINUS L	Child	05/21/1983	02/01/2007

Please select any dependents that should be changed with the same information as the Employee.

Current Group:	20883-000-00000-28011 FULLY INSURED
Enter the New Group Number:
Enter the Effective Date of the Group Change:	Format: MM/DD/YYYY
Hire Date:	Format: MM/DD/YYYY

ENR0007-Eff Date Does not Equal Waiting Period. Enter a Qualifying Event Code.

Qualifying Event: