Get Form 116m

Filling out the Form 116m is an essential step in providing accurate health insurance information for employees. This guide will help you navigate each section of the form online, ensuring you complete it correctly and efficiently.

Follow the steps to fill out Form 116m online

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by entering the employee information. Fill in the employee's name and Social Security number in the designated fields.
3. Next, provide the employer's information. Enter the employer's name, Employer Identification Number (EIN), phone number, and address, ensuring all details are accurate.
4. Indicate the contact person regarding employee health coverage by entering their name, phone number, and email address.
5. Answer the series of questions regarding health insurance policies by selecting 'Yes' or 'No' as appropriate. Make sure to provide explanations where required.
6. For questions that require date entries, input the eligibility dates and coverage changes in the specified format (mm/dd/yy).
7. Complete the sections regarding the employer’s least expensive plan or the Avenue H Default Plan with available premium and coverage information.
8. Fill out the employee's health plan choices, including insurance company details, policy numbers, and coverage specifics.
9. Review all entered information for accuracy, addressing any sections you may have missed or need to modify.
10. Once all necessary fields are completed and reviewed, save your changes, and you may have options to download, print, or share the form.

Complete the Form 116m online today for accurate and timely submission!