Get Premium Waiver And/or Leave Without Pay Form - South Carolina ... - Eip Sc

Filling out the Premium Waiver And/or Leave Without Pay Form is essential for employees seeking to manage their insurance benefits while on leave. This guide will provide clear, step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete your form.

1. Click the ‘Get Form’ button to access the Premium Waiver And/or Leave Without Pay Form. This will allow you to retrieve the document in a digital format.
2. Begin by entering your name in the 'Employee Name' field. Ensure that the spelling matches the name on your official records.
3. In the 'Employee BIN or SSN' field, provide your Employee Identification Number or Social Security Number. This information is crucial for identification purposes.
4. Fill in the 'Group Name' and 'Group Number' as listed on your insurance documents. This information helps connect your coverage to the correct group.
5. For the optional life premium waiver section, indicate whether the employee has returned to work or remains on an approved leave. Enter the corresponding date in the provided space.
6. Next, confirm if the Supplemental Long Term Disability Premium Waiver needs to be terminated by noting the appropriate return to work date and eligibility status.
7. In the Leave Without Pay section, select the relevant reason for the leave by checking the appropriate box. Additionally, provide the date that this leave began.
8. Ensure you sign and date the form where indicated. This section may require the Benefits Administrator's signature, depending on your organization's policy.
9. Finally, review the completed form for accuracy. You can then save your changes, download, print, or share the form as necessary.

Complete the Premium Waiver And/or Leave Without Pay Form online to manage your benefits seamlessly.