Interactive Demonstration - Enrollment Maintenance - Add Employee Review

July 30, 2010

Please review the following information.

Member Number:	00250631598
Group Number:	20883-000-00000-28011

Last Name:	Gonzalez
First Name:	Jesus Middle Initial: C
Gender:	Male
Date of Birth:	03/15/1942
Marital Status:	Single

Address Line 1:	300 Main Street
City:	ANYWHERE
State:	USA Zip Code: 55555

Hire Date:	01/01/2007
Effective Date:	04/01/2007
Qualifying Event:	Open Enrollment

Please review the data entered. Eligible dependents can be added following a successful employee add.