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Medical
TRS-ActiveCare 1
TRS-ActiveCare 2
TRS-ActiveCare 3 |
1.
Complete
TRS-ActiveCare
enrollment form, in
blue or black ink.
- To enroll
in coverage,
complete sections 1,
2, 3, 4, 5 (if
electing dependent
coverage), 7, 8 (if
applicable), and 10.
- To decline
coverage, complete
sections 1, 2 and 9
Be sure to sign and
date the form.
2.
Complete scan sheet
in pencil,
including dependent
information for
anyone you want
covered. Be sure
to sign and date the
form. |
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District provided
life coverage for
$20,000 |
List beneficiary on
scan sheet,
including
relationship and
address. This
designation replaces
anyone previously
listed as your
beneficiary and you
may list more than
one person.
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