Kansas Affidavit of No Coverage by Another Group Health Plan

State:
Multi-State
Control #:
US-321EM
Format:
Word; 
Rich Text
Instant download

Description

The employee named in this affidavit attests to the fact that he or she is not covered by any other group health plan.

How to fill out Affidavit Of No Coverage By Another Group Health Plan?

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FAQ

(B) The term plan sponsor means (i) the employer in the case of an employee benefit plan established or maintained by a single employer, (ii) the employee organization in the case of a plan established or maintained by an employee organization, (iii) in the case of a plan established or maintained by two or more

Continuation coverage allows someone who recently lost their employer-based health coverage to continue their current insurance policy as long as they pay the full monthly premiums.

Each year, employers, insurance companies and others who provide health insurance will tell the IRS who they've covered. And they'll give you a Health Coverage Information Statement Form 1095-B or Form 1095-C) as proof you had coverage.

A dependent is a person who is eligible to be covered by you under these plans.

A certificate of Creditable Coverage (COCC) is a document provided by your previous insurance carrier that proves that your insurance has ended. This includes the name of the member to whom it applies as well as the coverage effective date and cancelation date.

The primary purpose of the certificate is to show the amount of creditable coverage that you had under a group health plan or other health insurance coverage, because this can reduce or eliminate the length of time that any pre-existing condition clause in a new plan otherwise might apply to you.

Certificates of creditable coverage must be issued when a covered employee or dependent has a COBRA qualifying event or otherwise ceases to have coverage under the employer-sponsored health plan, when COBRA coverage ends, and upon request within 24 months after coverage ceases.

Plan sponsor is the entity that ultimately pays for the coverage, benefit, or insurance product. A sponsor can be an employer, union, government agency, association, or insurance agency.

If a Social Security agreement assigns coverage of the employee's work to the United States, the Social Security Administration issues a U.S. Certificate of Coverage. The certificate serves as proof that the employee and employer are exempt from the payment of Social Security taxes to the foreign country.

A plan sponsor is an employer or organization that offers a group health plan to its employees or members.

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Kansas Affidavit of No Coverage by Another Group Health Plan