Page 23 - Citizens Bank Benefit Guide 2020
P. 23
Marketplace Coverage Options
Continued
New Form Approved
OMB No.
PART B: Information About Health Coverage Offered by Your Employer
This sectio co tai s i formatio about a y health coverage offered by your employer. If you decide to complete a applicatio
for coverage i the Mar etplace, you will be as ed to provide this i formatio . This i formatio is umbered to correspo d to
the Mar etplace applicatio .
580-310-4437 hr@citizensada.com
23
