All Star Staffing Associates Elections

DO NOT COMPLETE IF: you have not been employed with All Star Staffing for at least one full year. You are eligible if you have been employed for ONE full year and worked at least 30 hours per week.

IF ELIGIBLE: This insurance REQUIRES you to pay 8.39% of your gross income / paycheck towards the cost of the insurance.

If you are currently enrolled and you select "Waive" you will be REMOVED from the insurance
Your Physician's name
YOU ARE AGREEING TO PAY 8.39% of your income towards the cost of the health insurance!

Also, the insurance is prepaid so you MUST give notice if you plan on ending your employment with All Star. Any prepaid premiums will be withheld from your final paycheck, and any refunds will be issued by the insurance company directly to you.
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