Get the free PEEHIP INSURANCE WAIVER NOTICE.pdf - Alabama A&M University - aamu

Alabama Agricultural and Mechanical University Office of Human Resources 4101 Meridian Street Huntsville, AL 35811 Phone: 256.372.5835 Fax: 256.372.5881 ACKNOWLEDGEMENT/WAIVE FORM I hereby acknowledge

How to fill out peehip insurance waiver noticepdf

How to fill out peehip insurance waiver noticepdf:

1. Download the peehip insurance waiver noticepdf form from the official website of the Alabama Education Retiree Health Benefit Trust (AERHBT).
2. Open the downloaded form using a PDF reader on your computer or device.
3. Begin by entering your personal information in the required fields. This may include your full name, address, phone number, and email address.
4. Provide your Social Security number or another unique identifier as requested on the form.
5. Indicate your current employment status, such as if you are an active employee or a retiree.
6. Specify the reason for requesting a waiver of the peehip insurance coverage. For example, if you have alternative insurance coverage through a spouse or another source, mention it here.
7. If applicable, provide the details of your alternative insurance coverage, including the insurer's name, policy number, and effective dates.
8. Sign and date the form to certify that the information provided is accurate to the best of your knowledge.
9. Review the completed form to ensure all required fields are filled out correctly.
10. Save a copy of the filled-out form for your records.
11. Submit the completed peehip insurance waiver noticepdf form as per the instructions provided by AERHBT.

Who needs peehip insurance waiver noticepdf:

1. Employees enrolled in the Alabama Education Retiree Health Benefit Trust (AERHBT) program who wish to opt-out of the peehip insurance coverage.
2. Retirees who have reached the age of eligibility for Medicare and want to waive their peehip insurance coverage.
3. Individuals who have alternative insurance coverage through a spouse, another employer, or a different source and wish to request a waiver of peehip insurance.

For pdfFiller’s FAQs

What is peehip insurance waiver noticepdf?

The peehip insurance waiver noticepdf is a form provided by the Public Education Employees' Health Insurance Plan (PEEHIP) for individuals to waive their health insurance coverage.

Who is required to file peehip insurance waiver noticepdf?

Employees who have alternative health insurance coverage and do not wish to enroll in the PEEHIP plan are required to file the insurance waiver noticepdf.

How to fill out peehip insurance waiver noticepdf?

To fill out the peehip insurance waiver noticepdf, individuals must provide their personal information, details of their alternative health insurance plan, and sign the form to officially waive coverage under PEEHIP.

What is the purpose of peehip insurance waiver noticepdf?

The purpose of the peehip insurance waiver noticepdf is to allow individuals to opt out of the PEEHIP health insurance plan if they have coverage through another provider.

What information must be reported on peehip insurance waiver noticepdf?

The peehip insurance waiver noticepdf requires individuals to report their personal information, details of their alternative health insurance plan, and a signature to waive coverage under PEEHIP.

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