Get The Purpose Of This Form Is To Determine If The Spouse/domestic ... - Bw

This guide will assist you in accurately completing the spousal/domestic partner health care eligibility determination form. This essential form helps determine the health care coverage eligibility for the spouse or domestic partner of a Baldwin-Wallace College employee.

Follow the steps to fill out the form effectively.

1. Click the ‘Get Form’ button to access the spousal/domestic partner health care eligibility determination form. This will open the form in your preferred editor for easy completion.
2. Begin by entering your name in the designated field labeled 'Employee Name (Please Print)'. Make sure to write clearly and legibly.
3. Next, provide the name of your spouse or domestic partner in the field labeled 'Name of Spouse/Domestic Partner (Please Print)'. Again, ensure clarity in your writing.
4. You will find the first question asking if your spouse or domestic partner has access to any employer-sponsored health care plan. Select either 'Yes' or 'No' based on your situation.
5. If you answered 'Yes' to question 1, you will need to answer question 2, which asks whether your spouse or domestic partner works full-time. Choose 'Yes' or 'No' to respond accurately.
6. At the bottom of the form, you will find an attestation statement. Read this carefully to understand your responsibilities regarding the truthfulness of the information provided.
7. Sign your name in the 'Employee Signature' field and indicate the date of signing. This confirms that all the information you provided is complete and truthful.
8. Once you have filled out all the required fields, review your entries for any errors. After verifying the information, you can save your changes, download a copy of the form, print it for your records, or share it with the appropriate office.

Complete your documentation online to ensure your spouse or domestic partner's health care eligibility.