Get the free NON‐SMOKER DISCOUNT AFFIDAVIT - onu
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This affidavit is for employees of Ohio Northern University to certify non-smoking status for eligibility towards medical plan premium discounts.
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How to fill out nonsmoker discount affidavit
How to fill out NON‐SMOKER DISCOUNT AFFIDAVIT
01
Obtain the NON‐SMOKER DISCOUNT AFFIDAVIT form from your insurance provider or their website.
02
Read the instructions carefully before starting the form.
03
Fill in your personal information, including your full name, address, and policy number.
04
Indicate your non-smoking status, confirming that you do not smoke tobacco in any form.
05
If applicable, include any necessary details about household members who also do not smoke.
06
Sign and date the affidavit to certify that the information provided is accurate.
07
Submit the completed affidavit to your insurance provider through the method specified in their instructions.
Who needs NON‐SMOKER DISCOUNT AFFIDAVIT?
01
Individuals who have a health insurance policy that offers a non-smoker discount.
02
Those who want to qualify for reduced premiums by confirming their non-smoking status.
03
Policyholders who have not previously submitted a non-smoker affidavit.
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What is a non smoking affidavit?
I certify that I have not regularly used cigarettes, cigars, pipes, chewing tobacco, smokeless tobacco, or any other form of tobacco within the last 6 months. Regular use is defined as 4 or more times per week, excluding religious or ceremonial use and the use of e-cigarettes.
What is a tobacco use affidavit?
This form is used to determine your premium rate. You are only eligible for the lower non-tobacco user rate after you can attest that you use tobacco products, on average, less than four (4) times per week for six (6) months or longer.
What is a non smokers declaration?
I declare that: • I haven't smoked tobacco or any other substances in the last 12 months. • I haven't used any nicotine replacement including e-cigarettes (with nicotine), vaping (with nicotine), nicotine gum, chewing tobacco, or patches in the last 12 months.
What is considered non smoking?
Standard Nonsmoker: No use of tobacco or nicotine-based products in last 12 months. All tobacco users are considered smokers.
What is a non smoker declaration?
I declare that: • I haven't smoked tobacco or any other substances in the last 12 months. • I haven't used any nicotine replacement including e-cigarettes (with nicotine), vaping (with nicotine), nicotine gum, chewing tobacco, or patches in the last 12 months.
What is a non smoking property?
It means exactly what it says. No smoking on the property. However, this could be narrowly defined as simply no smoking cigarettes or cigars or it could be more broadly defined as no using vapes or e-cigs, no using chewing tobacco or dip or using any other kind of tobacco product.
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What is NON‐SMOKER DISCOUNT AFFIDAVIT?
The NON‐SMOKER DISCOUNT AFFIDAVIT is a legal document that individuals submit to declare that they do not engage in smoking, in order to qualify for a discount on health insurance or related benefits.
Who is required to file NON‐SMOKER DISCOUNT AFFIDAVIT?
Individuals who want to receive a non-smoker discount on their health insurance premiums are typically required to file a NON‐SMOKER DISCOUNT AFFIDAVIT.
How to fill out NON‐SMOKER DISCOUNT AFFIDAVIT?
To fill out a NON‐SMOKER DISCOUNT AFFIDAVIT, an individual must complete the form by providing personal information, confirming their non-smoking status, and signing the affidavit to attest to the truthfulness of the information provided.
What is the purpose of NON‐SMOKER DISCOUNT AFFIDAVIT?
The purpose of the NON‐SMOKER DISCOUNT AFFIDAVIT is to verify that an individual does not smoke, allowing them to qualify for discounts on insurance premiums and potentially other health benefits.
What information must be reported on NON‐SMOKER DISCOUNT AFFIDAVIT?
The NON‐SMOKER DISCOUNT AFFIDAVIT must typically include the individual's full name, date of birth, address, a declaration of non-smoking status, and a signature confirming the accuracy of the provided information.
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