The North Dakota Affidavit of No Coverage by Another Group Health Plan is a legal document that serves as proof that an individual does not have any other existing group health insurance coverage. This affidavit is often required by employers or government agencies when enrolling in a group health plan. By stating that there is no other coverage, it ensures that the individual is eligible to enroll in the specific group health plan. The North Dakota Affidavit of No Coverage by Another Group Health Plan contains several essential sections that must be completed accurately. These sections include personal information such as the individual's full name, address, date of birth, and Social Security number. It also requires the individual to disclose information about their current employer and their employment status. Keywords related to the North Dakota Affidavit of No Coverage by Another Group Health Plan: 1. North Dakota: Refers to the specific state where this affidavit is applicable, ensuring compliance with the state's healthcare regulations. 2. Affidavit: A sworn statement made voluntarily by an individual under oath, verifying the accuracy of the information provided in the document. 3. No Coverage: Asserts that the individual does not possess any other active group health insurance coverage. 4. Group Health Plan: Refers to a healthcare plan provided by an employer or other organizations to eligible individuals, typically covering a group of employees. Different types of North Dakota Affidavit of No Coverage by Another Group Health Plan may include variations depending on the specific requirements of the employing organization or government agency. However, the core purpose of stating that no other group health plan coverage exists remains consistent. Other potential variations or instances where the affidavit may be required could be: 1. North Dakota Affidavit of No Coverage by Another Group Health Plan for State Government Employees. 2. North Dakota Affidavit of No Coverage by Another Group Health Plan for Federal Government Employees. 3. North Dakota Affidavit of No Coverage by Another Group Health Plan for Self-Employed Individuals. 4. North Dakota Affidavit of No Coverage by Another Group Health Plan for Dependents. It is essential to carefully review the specific requirements and guidelines provided by the issuing entity to ensure accurate completion of the affidavit.