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HomeMy WebLinkAboutChris Vierling Health and Dentalme to Online Enrollment Page 1 of 2 VIERLING , CHRISTOPHE M (Employee) V OC1157 : 010: SG SC PLAN 1 AG ACTIVES Effective Date: Jun 1 , 2008 Coverage Type: Family v14" OXG202 : 000: COMP STRD /CI157 -10 Effective Date: Jun 1 , 2008 Coverage Type: Family Subscriber ID: XZ4823000000 Client ID: -- Social Security Number: Gender: Male Birth Date: Dec 14, 1979 Marital Status: Single Address: 1333 5TH ST S City: STILLWATER State: MINNESOTA ZIP: 55082 Country: USA Home Phone: 651 - 270 -2619 Work Phone: 651 - 439 -4723 Enrollment Date: Jun 1, 2008 VIERLING , ALLISON (Dependent) OCI157 : 010: SG SC PLAN 1 AG ACTIVES Effective Date: Jun 1 , 2008 V,OXG202 : 000: COMP STRD /CI157 -10 Effective Date: Jun 1 , 2008 Social Security Number: GENDER: Female Birthdate: Feb 16, 1980 Relationship: Spouse Enrollment Date: Jun 1, 2008 VIERLING , ADAM (Dependent) OC1157 : 010: SG SC PLAN 1 AG ACTIVES Effective Date: Jun 1 , 2008 V/ OXG202 : 000: COMP STRD /CI157 -10 Effective Date: Jun 1 , 2008 Social Security Number: GENDER: Male Birthdate: Jun 23, 1997 Relationship: Child Enrollment Date: Jun 1, 2008 https:// www. blueerossnm. coml onlineenrollment lservletlWSNavigator ?_APPNAME= oegm... 9/25/2013 Welcome to Online Enrollment VIERLING , ZACHARY (Dependent) ✓ OCI157 : 010: SG SC PLAN 1 AG ACTIVES Effective Date: Jun 1 , 2008 '/ OXG202 : 000: COMP STRD /CI157 -10 Social Security Number: GENDER: Male Birthdate: Feb 28, 2006 Relationship: Child Enrollment Date: Jun 1, 2008 Effective Date: Jun 1 , 2008 VIERLING , VALERIE (Dependent) '/OCI157 : 010: SG SC PLAN 1 AG ACTIVES Effective Date: Jun 14, 2010 OXG202 : 000: COMP STRD /CI157 -10 Social Security Number: -- GENDER: Female Birthdate: Jun 14, 2010 Relationship: Child Enrollment Date: Jun 14, 2010 Effective Date: Jun 14, 2010 0 . " SlueC� SS ueShield ' �►' of Minnesota d Disclaimers and Trademarks ® Registered marks of the Blue Cross and Blue Shield Association ® 2006 Blue Cross and Blue Shield of Minnesota Page 2 of 2 https:// www. bluecrossmn. com/ onlineenrollment/ servletlWSNavigator ?_APPNAME= oegm... 9/25/2013