2022 Vision/Dental Open Enrollment

Forms

Enrollment Packet

What You Should Know

• This insurance is voluntary
• You must pay the quarterly premiums before your dues will be accepted. Be sure to review the rates.  Do not accept coverage if you cannot pay the premiums!
• You cannot cancel the coverage unless you have a qualifying event (coverage gained elsewhere)
• You must re-enroll to keep your current coverage
• Be sure to return the respective enrollment forms AND the signed contract
• We cannot accept late forms.
  Be sure to submit your forms AND contract NO LATER than November 30, 2021.
• Print the forms AND contract from the website (www.ualocal136.org – Resources Tab): complete, sign and return them to the union hall by mail, fax or email

How to Submit Your Forms & Contract