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For a low annual fee, your clients receive the same customer-friendly, knowledgeable advice and service as your local providers at a fraction of the cost. PlanLink is just $350 to setup and $750 a year. There are no per participant or eligible employee fees.

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E +4 CHANGES TO PERSONAL DATA Only complete this section if changes to Personal Data have occurred. Enter only the changed information. Social Security Number / Date of Birth First Name MI / / Date of Hire / Last Name Street Address City State Zip Code +4 PARTICIPANT AUTHORIZATION Signature of Participant Date AUTHORIZED EMPLOYER REPRESENTATIVE USE ONLY Date of Hire Date of Termination/Service Change Date of Birth Date of Rehire Enrollment Status: Active Retired Payr.

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