Charlee AI Election

Please enter your information to enroll/dis-enroll into the company benefit plans. If you want the benefit, make sure you select the plan you want. If you do not want the benefit, select "Waive". If you are CURRENTLY enrolled and "Waive" is showing, you will be REMOVED from the insurance. You are eligible to enroll 30 days after your date of hire and must work at least 30 hours per week

Your Physician's name
Please choose the date the insurance "turn on" / go into effect. Effective dates can ONLY be on the first day of the month (i.e. No mid-month effective dates).
Clear Signature