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Transaction Confirmation

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  Enrollee: CARMEL QUINN DIV: ELK Group: 22222 Insured ID: 222333444-00
         
Employee Information
   Demographic Information
   Product Information
   Other Insurance (optional)
   COBRA (optional)
                 
Employee Information
 
  TRANSACTION SUCCESSFUL
*Required fields
 

Original Date of Hire* 02/01/2002 Company ID    

Language* English      
 

Once you have correctly entered all required information and selected Submit, you will see a message similar to the one shown to the left on the sample screen. At this point, you can:

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  • Select another option from the menu.
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