CCADepVerForm - COVER SHEET To: Attached: Winston Financial...

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COVER SHEET To: Winston Financial Services FAX 1-732-903-1158 Attached: Dependent Verification Documents Employee Name: ______________________________________________ Employee ID: ______________ Contact phone: ____________________ Total number of pages including this cover sheet: _______ All previously unverified and new BCBST and Definity medical dependents must be verified with supporting documentation. Dependents over the age of 18 or with a different last name must also be verified for coverage under the vision and/or dental plans. The Dependent Verification process and rules are exactly the same as during the Dependent Eligibility Audit that was completed during the summer of 2009. You must fax or mail the supporting documentation for each newly covered dependent to Winston Financial Services. Given time constraints, faxing or e-mailing the information is preferable, especially toward the end of the Open Enrollment period. Winston Financial Services FAX 1-732-903-1158 E-Mail Address Documentation@WinstonFinancial.com Mailing Address Winston Financial Services PO Box A Bay Head, NJ 08742 Complete verification information must be postmarked or received by the end of the Open Enrollment period (February 19, 2010) or your unverified dependent(s) will be dropped and your benefit coverage tier will automatically be reduced accordingly. Before you fax this document, did you remember to include:
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CCADepVerForm - COVER SHEET To: Attached: Winston Financial...

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