Page 25 - Citizens Bank Benefit Guide 2020_Revised 12-11-2020
P. 25
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
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