Rule 800-6-7-.01

Ala. Admin. Code r. 800-6-7-.01

PEH 101-11-83- PEEHIP Member Record Form

Effective Jun 25, 1985Filed May 20, 1985; effective June 25, 1985.Retirement Systems of Alabama

Multi-purpose form used to establish insurance coverage, make changes in such coverage, and for cancellation of such coverage.

Author: William T. Stephens, General Counsel, RSA.

Statutory Authority: Code of Ala. 1975, § 41-22-4.

History: Filed May 20, 1985; effective June 25, 1985.