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Health Benefits Registration Form


Friday, November 15, 2013

If you were hired on or after October 1, 1987, you participate in the District healthcare program. Complete this form to enroll in the District Plan upon retirement or to make changes in your coverage during Open Enrollment periods or upon a change in family status. If you have questions, please contact the DCRB Member Services Center at the numbers listed above. Please return the completed form to DCRB.

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Health Benefits Registration Form155.31 KB