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Account Summary         View Enrollment History    Account Summary Subscriber Employer Information JACK SMITH GROUP ABC Active Employee Hired on 01/02/2005 Contact Information Address Phone Numbers/ Email 123 Knoll Crest Road Mt. Washington, NH  03555 Home Phone: 603-999-9999 Benefit Coverage Benefit Plan Selection Current Policy Period Policy Holder Since Medical HRA Choice Fund, Employee + Family 01/01/2007-12/31/2007 01/01/2007 Dental PPO Standard Dental Plan, Employee + One 01/01/2007-12/31/2007 01/01/2007 Flexible Spending Health Care Reimbursement Account, $2,400 Dependent Care Reimbursement Account $3,600 01/01/2007-12/31/2007 01/01/2007 Disability Short Term Disability, $30,000 Long Term Disability, $18,000 01/01/2007-12/31/2007 01/01/2007 Life Basic Life Insurance, 1X Salary Supplemental Life Insurance, 2X Salary Spouse-Dependent Life Insurance, $50,000 01/01/2007-12/31/2007 01/01/2007 Member Information Name Relation/ Status DOB Coverage Elections Coverage Period Coverage Status Jack Smith Self 09/25/1968 Medical Dental FSA Disability Life 01/01/2007-12/31/2007 Active Jane Smith Spouse Student 02/03/1968 Medical Dental 01/01/2007-12/31/2007 Active Josh Smith Child 02/03/1987 Medical 01/01/2007-12/31/2007 Active Jessica Smith Child 01/15/2007 Medical 01/15/2007-10/31/2007 Active Legal Disclaimer,  Privacy Policy, (06/10/2006) Copyright© 2000-2006 Choicelinx Corporation. All rights reserved.