Dental Vision Benefit Plan Snapshot

This form is only a confirmation of existing Guardian plan selections. Use this form if you are keeping everything the same as you are currently subscribed, for 2022. If you wish to change plans, drop coverage, etc, you MUST use the multi-page enrollment form.

*If you are unsure of your current plan, either cross reference the rate sheet against the premium being deducted from your payrolls, or simply write "NO CHANGES" on the form, & we will maintain your current set up.

2022 CABMSC Benefit Plan Snapshot Election Form doc.pdf, 121.03 KB; (Last Modified on October 27, 2021)