City of Zephyrhills

VOLUNTARY BENEFITS, BROCHURES & RATES

How To Enroll In Supplemental Insurance 

How To Enroll In Supplemental Insurance 

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Print the application for the carrier of your choice and fill out your basic information, select the plan(s) 

that you would like to have for Open Enrollment and sign the application.

(You can even use your pdf editor and do it electronically)

Do not worry about codes, etc. we just need your basic information, selections and signature.

Print the Payroll Deduction Authorization (P.D.A.), put your name and sign your payroll card.

Copy of PDA will be forwarded back to you with all codes filled out.

Turn in to Brad Shattuck or email your application and payroll deduction card to brad@benecom.com

Questions? Brad's cellular #813-293-7489


Print the application for the carrier of your choice and fill out your basic information, select the plan(s) 

that you would like to have for Open Enrollment and sign the application.

(You can even use your pdf editor and do it electronically)

Do not worry about codes, etc. we just need your basic information, selections and signature.

Print the Payroll Deduction Authorization (P.D.A.), put your name and sign your payroll card.

Copy of PDA will be forwarded back to you with all codes filled out.

Turn in to Brad Shattuck or email your application and payroll deduction card to brad@benecom.com

Questions? Brad's cellular #813-293-7489

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OPEN ENROLLMENT 2019 PRESENTATION
ALLSTATE
AFLAC
TRANSAMERICA LIFE INSURANCE BROCHURE AND RATES