(with a disability) or Qualifying Relative in medical and/or dental coverage. The Affordable Care Act requires group health plans to provide dependent medical coverage of children up to the age of 26. UWMF also offers a dental plan which covers unmarried dependents up to the age of 25. This form does not get completed in these cases. The University of Wisconsin Medical Foundation (UWMF) offers health and dental coverage to qualified domestic partners, qualified adult child(ren) or relative(s).
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How to fill out the UWMF Declaration Of Tax Status Form online
Filling out the UWMF Declaration Of Tax Status Form is essential for employees who want to enroll their domestic partner, qualifying child, or qualifying relative in health and dental coverage. This guide will provide clear instructions on how to complete the form online to ensure accurate tax status declaration.
Follow the steps to successfully complete the form online.
- Click ‘Get Form’ button to obtain the form and open it in the designated editor.
- In Section 1, determine the federal and/or state tax status of your domestic partner or qualifying relative. Apply the necessary tests — Test A for qualifying children and Test B for qualifying relatives. Refer to the criteria listed in the section to see if they qualify under IRC Section 152.
- For Section 2, list all individuals over the age of 18 whom you wish to enroll as a qualifying child or qualifying relative. Include their names, dates of birth, Social Security numbers, relationships to you, and indicate their federal and/or state tax status.
- In Section 3, provide your printed name and signature, confirming the accuracy of the information provided. Acknowledge the legal implications of false statements and your responsibility to report any changes in your domestic partnership or dependent status.
- After completing the form, ensure you save any changes made. Once satisfied, download or print the form for your records and submit it as instructed, either via fax or through HR.
Complete your UWMF Declaration Of Tax Status Form online to ensure compliance and accurate coverage.
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