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Loyola University Chicago fax number

(312) 915-7612

Human Resources - Benefits/Health Insurance

Used for: Spousal/LDA Premium Waiver submission during Open Enrollment (to waive the $100/month spousal premium) and related benefits enrollment confirmations

Fax destination details

Department
Human Resources - Benefits/Health Insurance
Purpose
Spousal/LDA Premium Waiver submission during Open Enrollment (to waive the $100/month spousal premium) and related benefits enrollment confirmations
Form
Spousal/LDA Premium Waiver Form — Spousal/LDA Premium Waiver
Address
820 N Michigan Ave, Suite 820, Chicago, IL 60611

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Complete the Spousal/LDA Premium Waiver during Open Enrollment. If your spouse/LDA is not employed or you prefer to certify online, use the Online Open Enrollment via Employee Self-Service to certify or re-certify your Spousal Premium attestation. If your spouse/LDA becomes employed or qualifies for other coverage, contact Human Resources at benefits@luc.edu.

Review official form instructions

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