FS1 Elections

DO NOT COMPLETE IF: you have not been employed with FS1 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 for the cost of insurance above $100 per month.

If you are currently enrolled and you select "Waive" you will be REMOVED from the insurance
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).
YOU ARE AGREEING TO PAY any costs / premiums over the first $100 per month for the health insurance! FS1 will pay the first $100, you will pay the rest.