Domestic Partner Affidavit Form Cigna

State:
Multi-State
Control #:
US-02268BG
Format:
Word; 
Rich Text
Instant download

Description

Affidavit of Domestic Partnership for Employer in Order to Receive Benefits
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How to fill out Affidavit Of Domestic Partnership For Employer In Order To Receive Benefits?

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FAQ

Documentation / Proof of RelationshipMunicipal domestic partnership registration. State domestic partnership registration. State civil union license. State marriage license. Marriage licenses issued in other countries.

We have a close and committed personal relationship and we are each other»s sole domestic partner not married to or partnered with any other spouse, spouse equivalent or domestic partner.We have provided true and accurate required documentation of our relationship.

246 requires that we inform you of, and make available to you, the option of coverage for your employees to add their eligible domestic partners as fully qualified dependents on their health plan or insurance certificate.

"Declaration of Domestic Partnership." A "Declaration of Domestic Partnership" is a statement signed under penalty of perjury. By signing it, the two people swear that they meet the requirements of the definition of domestic partnership when they sign the statement. Each must provide a mailing address.

We at Cigna take responsibility for domestic partners. A similar status allows us to offer them services to their customers. If you are living in a state where individuals are allowed to register as Domestic Partners, you must do so with your domestic partner.

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Domestic Partner Affidavit Form Cigna