Loading
Get Dhrm Utah 2020-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Dhrm Utah online
Filling out the Dhrm Utah form is an essential process for continuing your health and dental coverage under COBRA. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to successfully complete the Dhrm Utah form online.
- Click ‘Get Form’ button to obtain the form and open it in your editor.
- In Section A, enter your employee information. Provide your social security number and full name, including your last name, first name, and middle initial.
- Proceed to Section B. Fill out the applicant information, including their name, social security number, home address, the city, state, and ZIP code. Also, include the applicant's birth date and marital status by selecting from the options provided.
- Indicate the qualifying event that has triggered the need for COBRA coverage, such as termination of employment or a reduction in work hours. Be sure to include the relevant dates.
- In Section C, state the relationship of the applicants to the employee and fill in the full names of those to be covered, alongside their birth dates and social security numbers. Select the desired coverage types for each individual.
- Answer whether you or your dependents are covered by any other health or dental plan. Provide the relevant details, including the insurance company, policy holder name, and policy holder social security number.
- In Section D, read the agreement carefully before signing. Ensure to sign and date the form, confirming that the information provided is accurate. If enrolling a dependent of legal age, they should also sign and date the application.
- Once completed, save your changes. You may then download, print, or share the form as needed.
Complete your Dhrm Utah document online today to ensure your health and dental coverage.
To obtain a letter of good standing from the state of Utah, you can request it through the Utah Department of Commerce's online portal or by contacting them directly. This letter confirms that your business is compliant with state regulations. Utilizing DHRM Utah can provide further guidance on obtaining essential documents like these.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.