Get Mohawk Industries Spousal Healthcare Eligibility Affidavit 2020-2025

Filling out the Mohawk Industries Spousal Healthcare Eligibility Affidavit is an essential step in ensuring your spouse receives the appropriate healthcare benefits. This guide provides clear and detailed instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the affidavit online effectively.

1. Click ‘Get Form’ button to obtain the Mohawk Industries Spousal Healthcare Eligibility Affidavit and open it for editing.
2. Enter the employee's name and reference number in the designated fields at the top of the form.
3. Provide your spouse's name, gender, and last four digits of their social security number in the indicated sections.
4. In Section A, mark the appropriate box indicating your spouse's employment status and eligibility for coverage. Select options based on your spouse's current job situation as described in the list.
5. If your spouse's employer has coverage available and you are enrolling them in Mohawk's plan, be aware of the spousal surcharge and complete Section B. If not employing, skip this section.
6. Ensure that both you and your spouse sign the affidavit in the signature fields with the respective dates.
7. If Section B is applicable, have the spouse’s employer fill out the required fields, including their name, title, and signature.
8. Once all sections are completed, review the affidavit for accuracy. Save your changes, then prepare to download, print, or share the form as needed.

Complete your Mohawk Industries Spousal Healthcare Eligibility Affidavit online today to ensure your spouse receives the needed benefits.