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Daniel Moon

From: Chris Kim
Sent: Wednesday, July 08, 2015 6:21 PM
To: ACI.ALL
Cc: info@egins.com; Danilo Diaz (ddiaz@wordandbrown.com)
Subject: MEMORANDUM # 104 - B ( 2015 <Dental Insurance> Newly Added Benefit )
Attachments: (SAMPLE ONLY) (DENTAL) Application.pdf; (SAMPLE ONLY) (DENTAL) Decline.pdf;
(DENTAL) Application Form.pdf; (DENTAL) Plan Info & Rate.pdf; (DENTAL) Decline Form
(Decliner only).pdf

To: ACI ALL
< Newly Added Dental Benefit >
G
Please note that ACI decided to provide Dental Insurance Plan through the Delta Dental Insurance Company as
of 8/1/2015.
The application for enrollment (Includes Declination – (DENTAL) Decline Form) needs to be submitted to me either
through E mail or by hand no later than Wednesday 7/15/2015.

You may add your dependents in the policy at your own cost. ACI covers 100% of your premium (employee only).
Please make a note that insurance company Does Not Allow to add yourself and any dependent(s) after this
enrollment date or after 8/1/2015.

If you have further questions on the plan election and premium info, please contact EG Insurance Agency, Inc. and
contact Jay Lee by info@egins.com (E mail is preferred method of communication) or call @ 714 533 7089. Also, if you
need detailed explanations of coverage(s), please call Danilo Diaz, Word & Brown General Agency @ (800) 869 6989 for
more information.

The insurance agencies will be at our ACI office on 7/15/2015 (9 AM to 4 PM) to assist filling out the applications. . If
you are on the jobsite or not available on 7/15/2015, you may still get support by email and/or contacting the above
listed numbers.

[Dental Insurance (Newly Added Benefit)]

Also, Click and Download the files “ FORMS & INFORMATION (DENTAL) ”

Please refer “(SAMPLE ONLY)” for instruction..

1. Plan Election & Rate:
refer “(DENTAL) Plan Info & Rate”

2. Application: (Delta) :
Fill out “(DENTAL) Application Form “

3.. Benefit
Employee (only) 0% and ACI 100%

1