Get the free STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FO...
Show details
This form is used by active employees to certify that they and their covered dependents have not used tobacco products and to confirm completion of health assessments for eligibility in the health
We are not affiliated with any brand or entity on this form
Get, Create, Make and Sign state health benefit plan
Edit your state health benefit plan form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share your form instantly
Email, fax, or share your state health benefit plan form via URL. You can also download, print, or export forms to your preferred cloud storage service.
Editing state health benefit plan online
Follow the guidelines below to use a professional PDF editor:
1
Create an account. Begin by choosing Start Free Trial and, if you are a new user, establish a profile.
2
Upload a document. Select Add New on your Dashboard and transfer a file into the system in one of the following ways: by uploading it from your device or importing from the cloud, web, or internal mail. Then, click Start editing.
3
Edit state health benefit plan. Add and replace text, insert new objects, rearrange pages, add watermarks and page numbers, and more. Click Done when you are finished editing and go to the Documents tab to merge, split, lock or unlock the file.
4
Get your file. When you find your file in the docs list, click on its name and choose how you want to save it. To get the PDF, you can save it, send an email with it, or move it to the cloud.
Dealing with documents is always simple with pdfFiller. Try it right now
Uncompromising security for your PDF editing and eSignature needs
Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
How to fill out state health benefit plan
How to fill out STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FORM
01
Obtain the STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FORM from your employer's HR department or website.
02
Read through the instructions provided on the form to understand the requirements.
03
Fill in your personal information, including your name, employee ID, and contact details.
04
Indicate your non-tobacco usage status by checking the appropriate box on the form.
05
If applicable, provide any additional information or documentation that may be required.
06
Review the form for accuracy and completeness.
07
Sign and date the affidavit at the designated section.
08
Submit the completed form to your HR department by the specified deadline.
Who needs STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FORM?
01
Active employees who are enrolled in the STATE HEALTH BENEFIT PLAN (SHBP) and wish to affirm their non-tobacco user status.
02
Employees who want to be eligible for potential health insurance premium discounts associated with being a non-tobacco user.
Fill
form
: Try Risk Free
For pdfFiller’s FAQs
Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
What is STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FORM?
The STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FORM is a document that employees must complete to affirm their non-tobacco use status for eligibility for specific health benefits under the SHBP.
Who is required to file STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FORM?
Active employees enrolled in the STATE HEALTH BENEFIT PLAN who claim to be non-tobacco users are required to file the affidavit form.
How to fill out STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FORM?
To fill out the form, employees must provide their personal information, declare their non-tobacco use status, and sign the affidavit certifying the truthfulness of their claim.
What is the purpose of STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FORM?
The purpose of the affidavit form is to promote healthier lifestyles among employees and to assess eligibility for reduced health insurance premiums or benefits available to non-tobacco users.
What information must be reported on STATE HEALTH BENEFIT PLAN (SHBP) 2013 ACTIVE EMPLOYEE NON-TOBACCO USERS AFFIDAVIT FORM?
The form requires reporting of personal identifying information, a declaration of tobacco use status, and a signature to confirm the accuracy of the information provided.
Fill out your state health benefit plan online with pdfFiller!
pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.
State Health Benefit Plan is not the form you're looking for?Search for another form here.
Relevant keywords
Related Forms
If you believe that this page should be taken down, please follow our DMCA take down process
here
.
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.
