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  • Affidavit For Dependent Continuation Of Health Care Coverage ... - Franciscan

Get Affidavit For Dependent Continuation Of Health Care Coverage ... - Franciscan

Ended by the Health Care and Education Reconciliation Act of 2010 on March 30, 2010. PPACA provides for the extension of health insurance coverage to young adult children up to the age of 26. This coverage is available regardless of the qualifying young adult s marital status. In addition, it does not matter whether the qualifying young adults are tax dependents for federal income tax purposes. However, under a grandfathered plan, coverage is not extended if the adult child is eligible to enro.

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You're also responsible for submitting transactions during Open Enrollment for employees on a leave of absence who want to change plans or add/delete dependents. Employees who do not change plans or add/delete dependents during Open Enrollment may do so within 60 days from the date they return to regular pay status.

Family Member Type: Spouse The request must include a Health Benefits Election Form (Standard Form (SF) 2809) and a notarized statement signed by both the enrollee and the spouse. A draft statement is attached. A spouse's removal is considered a cancellation.

The Plan's Working Spouse Rule states that, if your spouse is working for an employer who offers a health plan, the Plan requires them to enroll in that employer-sponsored coverage to be eligible for Plan coverage. Your spouse must confirm whether they have access to and are enrolled in their employer's health plan.

The request must include proof that the child is no longer a dependent (by providing the enrollee's most recent tax return or a signed affidavit attesting that the child is no longer a dependent under the IRS definition of dependent) and a Health Benefits Election Form (Standard Form (SF) 2809).

When your child reaches age 26, they are no longer an eligible family member on your FEHB plan. Your child's coverage will continue at no cost for 31 days starting from the date the child turns 26 years old.

Wants to be Removed An eligible child may be removed from a Self Plus One or a Self and Family enrollment if a request is submitted to the enrollee's agency for approval. The child's request must include a notarized statement from the child. A child's removal is considered a cancellation.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232