Tennessee 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

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.

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.

Who is issued a certificate of insurance with a group insurance policy? The participant is issued a certificate of insurance with a group insurance policy.

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.

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.

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 term continuation coverage refers to the extended coverage provided under the group benefit plan in which an eligible employee or eligible dependent is currently enrolled.

COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end.

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.

Tennessee - Coverage can be extended for the remainder of the month in which it would have terminated, plus up to three additional months. An individual who loses access to group coverage during pregnancy can continue their coverage for at least the duration of the pregnancy plus six months.

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Tennessee Affidavit of No Coverage by Another Group Health Plan