Get the free Affidavit of Alternative Coverage/Refused Medical Coverage
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2017 Group Insurance Plan
Affidavit of Alternative Coverage/Refused Medical Coverage
PLEASE CHECK YOUR SELECTION BELOW:
I hereby elect to OPT-OUT of the medical, prescription drug, dental and vision
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What is affidavit of alternative coveragerefused?
Affidavit of alternative coveragerefused is a legal document stating that an individual has refused alternative insurance coverage.
Who is required to file affidavit of alternative coveragerefused?
Individuals who have refused alternative insurance coverage are required to file affidavit of alternative coveragerefused.
How to fill out affidavit of alternative coveragerefused?
To fill out affidavit of alternative coveragerefused, one must provide personal information and details about the alternative coverage that was refused.
What is the purpose of affidavit of alternative coveragerefused?
The purpose of affidavit of alternative coveragerefused is to document an individual's refusal of alternative insurance coverage.
What information must be reported on affidavit of alternative coveragerefused?
The affidavit of alternative coveragerefused must include personal information such as name, address, and details about the alternative coverage that was refused.
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