Get Purdue University Working Spouse Premium Waiver Request 2021-2025

This guide provides clear instructions on how to complete the Purdue University Working Spouse Premium Waiver Request online. Follow the steps outlined to ensure accurate completion and submission of the required form.

Follow the steps to complete the waiver request form.

1. Click the ‘Get Form’ button to access the waiver request document and open it in your preferred form editor.
2. Begin by filling in the printed employee name and printed spouse name fields at the top of the form. Make sure both names are spelled correctly.
3. Review the criteria for submission. This form is necessary if you are covering a spouse through a Purdue medical plan and your spouse meets specific employment conditions.
4. In the section for employer certification, your spouse’s employer must complete the designated fields. This includes confirming the eligibility for medical insurance and enrollment status.
5. The employer must provide their name, signature, printed name, and phone number in the relevant areas of the employer certification section.
6. After the employer's information is filled out, as the employee, read the certification statement carefully. By signing, you confirm the accuracy of the information provided.
7. Sign and date the employee certification section. Ensure that the date is current.
8. Once you have completed the form, save your changes. You can then choose to download, print, or share the form as required.

Complete your documents online with confidence today.