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CITY OF KINGSTON PREMIUM CONVERSION BENEFIT PLAN ELECTION FORM PLAN YEAR: JULY 1, 2016, THROUGH JUNE 30, 2017, NAME: DATE: EMPLOYEE ADDRESS: CITY: ZIP: Election for Benefits As an eligible employee

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How to fill out premium conversion benefit plan

01

Step 1: Contact your employer or human resources department to obtain the necessary forms for the premium conversion benefit plan.

02

Step 2: Review the eligibility requirements and make sure you qualify for the plan.

03

Step 3: Carefully read and understand the instructions on the forms.

04

Step 4: Complete the forms accurately and provide all required information.

05

Step 5: Submit the completed forms to your employer or human resources department within the specified deadline.

06

Step 6: Keep a copy of the completed forms for your records.

07

Step 7: Monitor your paycheck to ensure the premium conversion benefit is being applied correctly.

08

Step 8: Contact your employer or human resources department if you have any questions or concerns.

Who needs premium conversion benefit plan?

01

Employees who want to reduce their taxes by paying their health insurance premiums on a pre-tax basis.

02

Employees who have eligible health insurance plans offered by their employers.

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What is premium conversion benefit plan?

A premium conversion benefit plan allows employees to pay for their share of health insurance premiums on a pre-tax basis.

Who is required to file premium conversion benefit plan?

Employers offering health insurance benefits to their employees are required to file a premium conversion benefit plan.

How to fill out premium conversion benefit plan?

Employers can fill out the premium conversion benefit plan by providing the necessary information about the health insurance benefits offered to their employees.

What is the purpose of premium conversion benefit plan?

The purpose of a premium conversion benefit plan is to save employees money by allowing them to pay for health insurance premiums on a pre-tax basis.

What information must be reported on premium conversion benefit plan?

Information such as the health insurance premiums paid by employees, the coverage provided by the health insurance plan, and the employer contributions towards the premiums must be reported on the premium conversion benefit plan.

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