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If you complete an application for coverage through the Marketplace, you will be asked for information about our health plan. This form can only be completed during the annual open enrollment period after an employer updates their Employer Benefit Agreement (Form 120).The Signatory Authority must complete and sign this form to certify that all staff listed have submitted a valid benefits counseling. The plan sponsor of a plan with an approved MPRA benefit suspension as of March 11, 2021 (a plan. This addendum provides information on the medical and prescription coverage available and the rates. Attracting and keeping physician staff. Download the healthcare addendum to review the comprehensive findings and insights. Do not complete nor submit with your proposal.) 2. City Colleges of Chicago - Insurance Requirements. Response: Weekly LCTCS generates a full eligibility file that should be uploaded into the Benefit Administration system.