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This document outlines the process and conditions under which full-time employees of the City of Springfield can waive dependent health and dental coverage if their dependents have other medical insurance
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How to fill out 2013 City of Springfield Medical and Dental Dependent Coverage Waiver
01
Obtain a copy of the 2013 City of Springfield Medical and Dental Dependent Coverage Waiver form.
02
Read the instructions provided with the form carefully.
03
Fill out your personal information at the top of the form, including your name, employee ID, and contact information.
04
Indicate whether you are waiving coverage for your dependents by checking the appropriate box.
05
List the names and relationship of any dependents you are waiving coverage for.
06
Sign and date the form to certify your waiver of coverage.
07
Submit the completed form to the Human Resources department or designated office by the deadline specified.
Who needs 2013 City of Springfield Medical and Dental Dependent Coverage Waiver?
01
Employees of the City of Springfield who have dependents but choose not to enroll them in the Medical and Dental plan.
02
Employees looking to waive their dependent coverage for financial or personal reasons.
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What is 2013 City of Springfield Medical and Dental Dependent Coverage Waiver?
The 2013 City of Springfield Medical and Dental Dependent Coverage Waiver is a document that allows eligible employees to waive coverage for their dependents under the city's medical and dental insurance plans, indicating that they have alternative coverage.
Who is required to file 2013 City of Springfield Medical and Dental Dependent Coverage Waiver?
Employees of the City of Springfield who wish to waive dependent medical and dental coverage offered by the city must file the 2013 City of Springfield Medical and Dental Dependent Coverage Waiver.
How to fill out 2013 City of Springfield Medical and Dental Dependent Coverage Waiver?
To fill out the 2013 City of Springfield Medical and Dental Dependent Coverage Waiver, employees must provide their personal information, specify the reason for waiving coverage, and indicate confirmation of alternative health coverage for their dependents.
What is the purpose of 2013 City of Springfield Medical and Dental Dependent Coverage Waiver?
The purpose of the 2013 City of Springfield Medical and Dental Dependent Coverage Waiver is to formally document an employee's decision to decline dependent coverage and ensure that they are aware of the implications of not having the city's insurance for their dependents.
What information must be reported on 2013 City of Springfield Medical and Dental Dependent Coverage Waiver?
The information that must be reported on the 2013 City of Springfield Medical and Dental Dependent Coverage Waiver includes employee details, dependent names, the reason for waiving coverage, and the details of any alternate insurance coverage.
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