Get the free Group Benefits Non-smoking Declaration - smu
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This document is to be completed by the plan member or spouse to qualify for reduced non-smoker optional benefit rates, declaring that they have not used tobacco in any form within the last 12 months.
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How to fill out group benefits non-smoking declaration
How to fill out Group Benefits Non-smoking Declaration
01
Read the instructions carefully.
02
Provide your full name at the top of the form.
03
Indicate your date of birth.
04
Fill in your contact information, including address and phone number.
05
Answer the questions regarding your smoking habits, ensuring to clarify whether you currently smoke or have quit.
06
If applicable, provide the date you quit smoking.
07
Sign and date the declaration at the bottom of the form.
08
Submit the completed declaration to the designated benefits administrator.
Who needs Group Benefits Non-smoking Declaration?
01
Individuals participating in a group benefits plan.
02
Employees or members who are required to declare their smoking status for eligibility.
03
Those seeking to obtain discounts on premiums associated with non-smoking status.
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What is Group Benefits Non-smoking Declaration?
The Group Benefits Non-smoking Declaration is a document that individuals submit to confirm their non-smoking status for the purposes of qualifying for specific health insurance benefits.
Who is required to file Group Benefits Non-smoking Declaration?
Typically, individuals participating in a group benefits plan who wish to declare their non-smoking status in order to receive certain benefits or lower premiums are required to file the Group Benefits Non-smoking Declaration.
How to fill out Group Benefits Non-smoking Declaration?
To fill out the Group Benefits Non-smoking Declaration, individuals must provide personal information, indicate their non-smoking status, and may also need to sign or date the declaration as per the requirements of their benefits provider.
What is the purpose of Group Benefits Non-smoking Declaration?
The purpose of the Group Benefits Non-smoking Declaration is to allow individuals to officially declare their non-smoking status, which can lead to eligibility for reduced premiums or additional health benefits related to non-smoker status.
What information must be reported on Group Benefits Non-smoking Declaration?
The information that must be reported includes the individual’s name, contact details, a declaration of non-smoking status, and possibly additional personal health information as required by the benefits provider.
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