HEALTH
Unit ID
Option ID+D(if has Dental)
Employee SSN
SSN Suffix
Employee Sex
Relationship to Employee (1- Employee, 2- Spouse, 3- Dependant)
Start Date of Coverage
End Date of Coverage
Employee Last Name
Employee First Name
Employee Home Address
Employee City
Employee State
Employee Zip
Employee Date of Birth
Option ID+D(if has Dental)