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

This guide provides a step-by-step approach on how to accurately complete the spousal/domestic partner health care eligibility determination form online. Our goal is to support users in understanding each section of the form to ensure proper submission.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by entering your name in the 'Employee Name' field. This section requires your full name as printed.
3. In the 'Name of Spouse/Domestic Partner' field, write the full name of your spouse or domestic partner. Again, ensure this is printed clearly.
4. Respond to the first question regarding their access to an employer-sponsored health care plan. Select 'Yes' if applicable, or 'No' if not.
5. If you selected 'No' for question 1, your spouse/domestic partner is eligible for coverage under Baldwin-Wallace’s health care plan. If you answered 'Yes,' proceed to the next question.
6. If your spouse/domestic partner has access to an employer-sponsored health care plan, indicate whether they work full-time by selecting 'Yes' or 'No'.
7. If both question 1 and question 2 were answered 'Yes', your spouse/domestic partner is not eligible for coverage under Baldwin-Wallace's health care plan.
8. Read the attestation statement carefully. This confirms that you understand the implications of providing false information and the importance of keeping Human Resources informed of any changes.
9. Provide your signature in the designated area and write the date of submission, ensuring both are completed accurately.
10. Once all fields are filled in, save your changes to the document, and choose to download, print, or share the form as needed.

Complete the necessary forms online today to ensure health care eligibility for your spouse or domestic partner.