New York 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

This document explains the health benefits you and your dependents have under the plan. It details the services that will and will not be covered. Services that are not covered are called exclusions.

Insurance companies typically require 100 percent of eligible employees to participate in noncontributory 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.

Definition of noncontributory : making or involving no contribution: such as. a : involving, relating to, or being an employee benefit (such as a pension plan) which is entirely funded by the employer with no contribution from the employee a noncontributory pension noncontributory life insurance plans.

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

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.

A contributory pension plan requires the employees to pay into the plan from their salary (the employees' pay stub would show the money was taken out of their pay to go into the pension plan). In a non-contributory pension plan only the employer contributes.

Noncontributory - Group life insurance plans are those in which the employer pays the entire premium and the employee supplies no portion of the premium costs. Employers have the option of contributing to the employees' premium payments in part or in full.

How do I enroll my domestic partner in health benefits through the City of New York? Relations website at and select Health Benefits. a letter to you. You can present that letter to your welfare fund to verify that your domestic partner is eligible for coverage.

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.

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New York Affidavit of No Coverage by Another Group Health Plan