Get Waiver Of Coverage - Kash Browne And Associates

Filling out the Waiver Of Coverage form is an essential step for employees choosing to opt out of group insurance coverage. This guide provides clear, step-by-step instructions to help users successfully complete the form online.

Follow the steps to accurately fill out the Waiver Of Coverage form.

1. Click the ‘Get Form’ button to access the Waiver Of Coverage form and open it in the editor.
2. In Section 1, provide the group information by entering the group name and group number. This section identifies the specific insurance group you belong to.
3. Proceed to Section 2, where you will fill in your employee information. Enter your last name, first name, and middle initial, along with your date of hire and the average number of hours you work per week.
4. Indicate who is waiving coverage by selecting either 'Employee' or 'Employee/Dependents.' If dependent coverage is being waived, list the name(s) of the dependent(s) (last, first, middle) along with their relationship to you.
5. Move to Section 3, where you will specify your reason for waiving coverage. You may choose to indicate that you do not wish to enroll or that you have other qualifying coverage. Complete the necessary fields about your existing coverage, if applicable.
6. Review the statements in Section 3, confirm your understanding of the implications of waiving coverage, and ensure the accuracy of all provided information. This section requires careful consideration as it outlines potential waiting periods for future enrollments.
7. Finally, provide your signature and the date in the designated fields to certify that all information is true and complete. Take a moment to review your entries one last time.
8. Once you have filled out the form, save your changes, and download or print the completed form for your records. You can also share the form with your group administrator as needed.

Start filling out your Waiver Of Coverage form online today to ensure your insurance choices are appropriately documented.