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The Commonwealth of Massachusetts Health Policy Commission Office of Patient Protection 50 Milk Street, 8th Floor Boston, MA 02109 (800)4367757 (phone) (617)6245046 (fax) 2017 Insurance Open Enrollment
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Template 2017 Insurance Open Enrollment Waiver Ination and Instructions instructions

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Insurance open enrollment waiver allows individuals to opt out of enrolling in an insurance plan during the designated enrollment period.
Individuals who are eligible for insurance coverage during open enrollment but choose not to enroll are required to file an insurance open enrollment waiver.
To fill out insurance open enrollment waiver, individuals need to provide their personal information, reason for opting out of coverage, and signature acknowledging their decision.
The purpose of insurance open enrollment waiver is to give individuals the option to decline coverage during the open enrollment period if they have alternative insurance or do not wish to enroll in a plan.
Information such as personal details, reason for opting out of coverage, and date must be reported on insurance open enrollment waiver.
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