Unite Here Local 1 - Healthcare Intake Form
Fill out this form to help us figure out how to help you re-enroll in other types of healthcare, if your Union healthcare runs out during the Covid19 layoffs. It should take about 10 minutes to fill out. If you're receiving unemployment, please have your "UI Findings Letter" that you got from IDES ready.

After you fill out this intake form, we will contact you within about a week by text message and/or email. We'll send you information about what healthcare option is best for each member of your family, based on your answers to this form.


Opt-in to texts: By giving your cell phone number, you are opting in to receive text messages from UNITE HERE Local 1. Standard message & data rates may apply; check with your service provider for details. [You can unsubscribe at any time.]

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填写这张表格为了帮助我们理解怎么帮助您注册其他类型的健康保险如果在新冠肺炎的裁员期间您的工会健康保险用完了或者会用完了。填写需要大概10分钟。如果您领取失业保险金,请准备好您从IDES(失业保险办公室)获得的 “UI Findings Letter” 。

填写这张表格以后,在大概一周内我们会与您联系通过短信和/或电子邮件。根据您表格的回答,我们会向您发送信息有关哪种健康保险选择最适合您和您家人。

*选择加入短信:通过提供您的手机号码,您可以选择从UNITE HERE Local 1接收短信。标准数据和短信费率可能适用;有关详细信息,问你的服务提供商。 [您可以随时取消订阅。]
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