Form preview

Get the free Coverage Election by Employee Who is an Officer of a Corporation, Manager of an LLC,...

Get Form
This document serves as a coverage election form for employees who are officers, managers, or members of an LLC, allowing them to elect to be excluded from workers' compensation coverage or revoke
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign coverage election by employee

Edit
Edit your coverage election by employee form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your coverage election by employee form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing coverage election by employee online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use our professional PDF editor, follow these steps:
1
Log in to your account. Click on Start Free Trial and register a profile if you don't have one.
2
Simply add a document. Select Add New from your Dashboard and import a file into the system by uploading it from your device or importing it via the cloud, online, or internal mail. Then click Begin editing.
3
Edit coverage election by employee. Rearrange and rotate pages, insert new and alter existing texts, add new objects, and take advantage of other helpful tools. Click Done to apply changes and return to your Dashboard. Go to the Documents tab to access merging, splitting, locking, or unlocking functions.
4
Save your file. Select it from your list of records. Then, move your cursor to the right toolbar and choose one of the exporting options. You can save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud, among other things.
pdfFiller makes working with documents easier than you could ever imagine. Register for an account and see for yourself!

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.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out coverage election by employee

Illustration

How to fill out Coverage Election by Employee Who is an Officer of a Corporation, Manager of an LLC, or Member of a Multiple-Member LLC

01
Obtain the Coverage Election form from your HR department or company website.
02
Fill out your personal information, including your name, position, and company details.
03
Specify whether you are an Officer of a Corporation, Manager of an LLC, or Member of a Multiple-Member LLC.
04
Indicate your desired coverage options in the designated sections of the form.
05
Review the filled form for accuracy and completeness.
06
Sign and date the form to confirm your election.
07
Submit the form to the appropriate department (e.g., HR or Payroll) by the specified deadline.

Who needs Coverage Election by Employee Who is an Officer of a Corporation, Manager of an LLC, or Member of a Multiple-Member LLC?

01
Employees who hold an officer position in a corporation.
02
Managers of Limited Liability Companies (LLCs).
03
Members of a Multiple-Member LLC who wish to elect coverage.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
20 Votes

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.

Coverage Election by Employee refers to the process in which individuals who serve as officers of a corporation, managers of an LLC, or members of a multiple-member LLC can choose to opt into or out of coverage under certain employer-sponsored benefit plans or retirement systems.
Individuals who qualify as officers of a corporation, managers of an LLC, or members of a multiple-member LLC and wish to claim specific coverage under employer-sponsored benefits are typically required to file the Coverage Election.
To fill out the Coverage Election, individuals must provide specific personal and organizational details, indicate their eligibility status, and select their coverage preferences based on the options outlined in the governing documentation or forms provided by the employer.
The purpose of the Coverage Election is to formally document the individual's choice regarding participation in employee benefit plans or other coverage options offered by the business entity, ensuring compliance with legal and regulatory requirements.
The information that must be reported typically includes the individual's name, position, entity type (Corporation, LLC, etc.), election option (opt-in or opt-out), and any relevant identification numbers or documentation required by the employer or regulatory bodies.
Fill out your coverage election by employee 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.

Get started now
Form preview
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.