Get the 2018 PLAN YEAR TOBACCO-FREE AFFIDAVIT - hr.iu.edu - hr iu

2018 PLAN YEARTOBACCOFREE AFFIDAVIT A TobaccoFree Affidavit must be completed by the employee to receive a reduction in the 2018 medical premium contribution. The employee can also certify the nonuser

How to fill out 2018 plan year tobacco

How to fill out 2018 plan year tobacco

1. To fill out the 2018 plan year tobacco, follow these steps:
2. Obtain the 2018 plan year tobacco form from the respective provider or organization.
3. Read through the instructions carefully to understand the information required and any specific guidelines.
4. Provide personal details such as name, date of birth, and contact information as requested on the form.
5. Indicate the type of tobacco usage you have, whether it is smoking, smokeless tobacco, or other forms.
6. Specify the frequency and duration of tobacco usage, including the number of cigarettes smoked per day or the amount of smokeless tobacco consumed per week.
7. Answer any additional questions regarding tobacco usage, such as previous quit attempts or participation in tobacco cessation programs.
8. Review the completed form for accuracy and make any necessary corrections.
9. Sign and date the form as required.
10. Submit the filled-out form to the designated provider or organization by the specified deadline.
11. Keep a copy of the filled-out form for your records.

Who needs 2018 plan year tobacco?

1. Individuals who are enrolled in a healthcare plan for the year 2018 and have used tobacco products during that period may need to fill out the 2018 plan year tobacco form.
2. This requirement is typically applicable to those individuals who are seeking certain tobacco-related discounts, benefits, or services through their healthcare plan.
3. It is advisable to check with your specific healthcare provider or insurance company to determine if you are required to complete the 2018 plan year tobacco form.

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What is plan year tobacco- affidavit?

Plan year tobacco-affidavit is a form that employers must complete to report whether their employees use tobacco products.

Who is required to file plan year tobacco- affidavit?

Employers who offer health insurance to their employees and have employees who use tobacco products are required to file the plan year tobacco-affidavit.

How to fill out plan year tobacco- affidavit?

Employers must provide information about the number of employees who use tobacco products and details about the health insurance coverage offered.

What is the purpose of plan year tobacco- affidavit?

The purpose of plan year tobacco-affidavit is to assess the impact of tobacco use on health insurance premiums and coverage.

What information must be reported on plan year tobacco- affidavit?

Employers must report the number of employees who use tobacco products, the type of health insurance coverage offered, and any changes in tobacco use policies.