Get the free SpousalInsuranceOptionElection-RejectionForm.doc - local195funds

Roofers Local #195 Health, Accident & Pension Funds 6200 State Route 31 Cicero, NY 13039 Phone: (315× 6991388 Fax: (315× 6991390 Spousal Insurance Option Election×Rejection Form Member Name: Spouse

How to fill out spousalinsuranceoptionelection-rejectionformdoc - local195funds

How to fill out spousalinsuranceoptionelection-rejectionformdoc - local195funds:

1. Start by downloading the spousalinsuranceoptionelection-rejectionformdoc from the local195funds website.
2. Open the form in a PDF editor or print it out if you prefer to fill it out manually.
3. Begin by entering your personal information, such as your name, address, and contact number, in the designated fields.
4. Next, provide the necessary details about your spouse, including their name and relationship to you.
5. Indicate whether you want to opt-out of the spousal insurance option or reject it by checking the appropriate box.
6. If you are rejecting the spousal insurance option, you may need to provide a reason for your decision. Write a brief explanation in the space provided if necessary.
7. Review the completed form to ensure all information is accurate and legible.
8. If filling out the form digitally, save it on your computer. If filling it out manually, make a photocopy for your records.
9. Submit the form as instructed by the local195funds. This may involve mailing it to a specific address or submitting it electronically.

Who needs spousalinsuranceoptionelection-rejectionformdoc - local195funds:

1. Employees who are eligible for spousal insurance coverage through the local195funds.
2. Employees who wish to decline the spousal insurance option for their spouse.
3. Individuals looking to provide alternative insurance coverage for their spouse outside of the local195funds.

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