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Benefit Enrollment and Life Event Change Form - Medical & Dental Benefits - Legislators and Exec Councilors - New Hampshire
Benefit Enrollment and Dental Benefits - Legislators and Exec Councilors is a legal document that was released by the New Hampshire Department of Administrative Services - a government authority operating within New Hampshire.
FAQ
Q: What is the Benefit Enrollment and Life Event Change Form?
A: The Benefit Enrollment and Life Event Change Form is a document used to enroll or make changes to medical and dental benefits.
Q: Who is the form applicable to?
A: This form is applicable to Legislators and Exec Councilors in New Hampshire.
Q: What is the purpose of the form?
A: The form is used to enroll in or make changes to medical and dental benefits for eligible individuals.
Form Details:
- Released on October 28, 2021;
- The latest edition currently provided by the New Hampshire Department of Administrative Services;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Administrative Services.
Download Benefit Enrollment and Life Event Change Form - Medical & Dental Benefits - Legislators and Exec Councilors - New Hampshire
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