Benefit Selection

Person#: 12348 / Card#: 654900211

If you have questions about your flex benefit options please contact BCHS by email at cwitney@bchs.bc.ca

Explanation
Requested Effective Date:    (DD-MMM-YYYY)
Reason for change:  
Person Status Information
Person Status  
Person Information
Annual Earnings Amount: $
Vacation Day Value:  
Eligible Dependents for EHC and Dental:  
Annual Flex Credit Amount: $
Flex Benefit Selection
Monthly Flex Credit Amount:$
Current Flex Credit Balance (Must be $0 or more):$
Group Life:
Employee coverage of   Benefit Information Selection Info =$
Dependent Life:
Dependent coverage of   Benefit Information Selection Info =$
AD&D:
Employee coverage of   Benefit Information Selection Info =$
Long Term Disability:
Employee coverage for   Benefit Information Selection Info =$
Extended Health Care:
Coverage with   Benefit Information Selection Info =$
Dental:
Coverage with   Benefit Information Selection Info =$
Vacation Days:
Buy back    vacation days per year @ $ per day.  Benefit Information Selection Info =$
 
Current Flex Credit Balance (Must be $0 or more):$
Balance Allocation:
Allocate the Flex Credit Balance to  

 

Verification
Selection Request Status:
Approved Effective Date:  (DD-MMM-YYYY)
Notes: