Sun Life Enrollment Application
4 |Benefit elections You need to complete all sections of the enrollment form including electing or refusing insurance coverage below from one of the insurance companies and service providers above and sign it. This must be done either during the enrollment period or within days of your eligibility date. Benefits completely paid by your employer (“non-contributory benefits”) cannot be refused. Not all of the benefit options listed below will be necessarily available to you. Your employer will tell you which benefits are available and what your Maximum Guaranteed Issue amount is.
Elect
Refuse Coverage Cancer:
Level 1 / Low plan
Level 2 / High plan
Employee
Employee + Spouse/partner
Employee + Child(ren) Employee + Family Have you used tobacco in any form in the past 12 months?.......................................
Yes No
Group Enrollment Form Page 2 of 3
GVMPEM-5627
24 STERLING ESTATES 2023 BENEFITS GUIDE
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