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Ancillary Benefit Enrollment Form

Ancillary Benefits

For the 2023-2024 Plan Year starting on 12/1/2023 please select an option for legal coverage.

LegalEASE Legal(Required)

I understand by selecting an option other than waiver, that I am authorizing a deduction from my wages as listed above for an employee contribution for this benefit coverage. I also understand that the plan is administered to me by JCC as determined in the sponsored plan document in accordance with the underwriting guidelines of the individual plan(s).

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