OWA Health Plan Cost Estimator 12.01.2017-11.30.2018.xlsx
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OWA Medical Plan Monthly Rates - EFFECTIVE 12/01/17-11/30/18
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EMPLOYEE ENROLLMENT WORKSHEET FOR:
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Name:
Jane Architect
Effective: 1/1/2018
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Subscriber's DOB:5/27/1975
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Dependent ENROLLMENT WORKSHEET FOR:
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Spouse
Spouse DOB:
12/30/1899Age as of 12/1/2017N/a
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Dependent 1 Dep DOB12/30/1899Age as of 12/1/2017N/a
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Dependent 2 Dep DOB12/30/1899Age as of 12/1/2017N/a
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Dependent 3 Dep DOB12/30/1899Age as of 12/1/2017N/a
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Dependent 4 Dep DOB12/30/1899Age as of 12/1/2017N/a
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STEP 1 MEMBER INFO
STEP 2 SEE QUOTE
Medical Rates