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Declination of Coverage Form Western Health AdvantageCERTIFICATION OF OTHER COVERAGE, I understand that I have been offered coverage through my employer in Western Health Advantage (WHA). I voluntarily choose

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What is wha declination of coverage?

WH-5 Declination of Coverage is a form that allows employees to decline health coverage offered by their employer.

Who is required to file wha declination of coverage?

Employees who choose to decline health coverage offered by their employer are required to file WH-5 Declination of Coverage.

How to fill out wha declination of coverage?

Employees can fill out WH-5 Declination of Coverage by providing their personal information, indicating their decision to decline coverage, and signing the form.

What is the purpose of wha declination of coverage?

The purpose of WH-5 Declination of Coverage is to document an employee's decision to decline health coverage offered by their employer.

What information must be reported on wha declination of coverage?

Information such as employee's name, employer's name, date of decline, and employee's signature must be reported on WH-5 Declination of Coverage.

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