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Daniel Moon

From: Chris Kim
Sent: Thursday, December 24, 2015 11:27 AM
To: ACI.ALL
Cc: jay@egins.com; info@egins.com
Subject: MEMORANDUM # 108 ( 2016 <Vision Insurance> Newly Added Benefit )
Attachments: Vision Application (Sample only).pdf; Vision Application Form.pdf; Vision Insurance
Declination Form.pdf; Vision Plan info & Rate.pdf

To: ACI ALL
< Newly added Vision Benefit >
G
Please note that ACI decided to provide Vision Insurance Benefit through the First Choice insurance company as
of 1/1/2016.
The application for enrollment (Includes Declination – (VISION) Decline Form) needs to be submitted to me either
through E mail or by hand no later than Wednesday 12/30/2015.

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.

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.

[Vision Insurance (Newly Added Benefit)]
Please refer “(Sample only)” for instruction.

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

2. Application: (First Choice) :
Fill out “(VISION) Application Form “

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

4. Vision Benefit Declination
Fill out: “ (VISION) Insurance Declination Form (Decliner only) “

Thank you,
Wishing you and your family a very Merry Christmas and a Happy New Year !

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