The Healthcare Plan: additional information form is personal and confidential. Ask your employee to complete this form, to sign it and send it in a sealed envelope to the attention of the medical advisor at AG Insurance, Boulevard Emile Jacqmain 53, 1000 Brussels

• if you want to add this employee (and their family members) to the healthcare plan and the agreement stipulates that medical formalities are applicable
  or
• if other members of the employee's family became affiliates after the employee.