Benefit Election Form definition

means the form provided by the Plan Administrator to Employees for the purpose of joining the Pretax Benefit Plan.

Based on 8 documents

means the Form attached as Exhibit 3.

Based on 6 documents

Examples of Benefit Election Form in a sentence

• I certify that I have read, understand, and agree to the terms outlined on this Benefit Election Form.
• The Participant has agreed to contribute the sum indicated on the Benefit Election Form to the HSA established hereunder.
• Each employee who is eligible for medical and dental insurance coverage may participate in the Pretax Benefit Plan by completing a Benefit Election Form within the Benefit Election Period.
• You can apply at any time to increase coverage by filling out a new Benefit Election Form and a Long Term Care/Evidence of Insurability Application.
• A Benefit Election Form once filed will remain in effect until the earlier of (a) the Employee’s ineligibility for coverage under the Insurance Plan for whatever reason; and (b) the filing of a new Election Form.

More Definitions of Benefit Election Form

means the form set forth as Exhibit A, or any successor form provided by the Compensation Committee, on which the Employee elects the manner in which his benefit under this Agreement will be paid.