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This guide provides clear and supportive instructions for users on how to fill out the Villagebhi Spousal Surcharge Affidavit online. Follow the steps carefully to ensure accurate completion of the form.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the Spousal Surcharge Affidavit. This action will open the form for you to complete.
2. Begin by entering the policyholder or plan employee's name in the designated field. This ensures the form is associated with the correct individual.
3. Review the checkbox options regarding your spouse's employment status. Select the box that best describes your spouse's situation — whether they are employed without health benefits, unemployed, or have coverage through another source.
4. If your spouse is employed but not eligible for health benefits, attach a letter on the employer’s letterhead. Ensure it includes the employer contact person’s name and phone number, verifying your spouse's eligibility.
5. For an unemployed spouse, provide a copy of the prior year’s federal tax return showing their status, ensuring financial information is blocked out. Alternatively, attach a signed, notarized statement if they have recently become unemployed.
6. If you elect to cover your spouse who has alternative health coverage, acknowledge that a surcharge will apply, and proceed accordingly.
7. By signing the form, you attest that the provided information is accurate to the best of your knowledge. Date the form appropriately.
8. Finally, provide the full legal name of your spouse in the appropriate field.
9. Once all sections are complete, save your changes to the document. You may then download, print, or share the form as required.

Complete your documents online today and ensure your spouse's enrollment is processed without delay.