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LAMBERTVILLE UNIFIED SCHOOL DISTRICTEMPLOYEE HEALTH PLAN201819 DECLINATION OF COVERAGE FORM COMPLETE ONLY IF YOU ARE DECLINING THE MEDICAL COVERAGE OFFERED BY THE LAMBERTVILLE UNIFIED SCHOOL DISTRICT
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Start by downloading the 2018-19 declination of coverage form from the official website.
02
Read through the form carefully to understand the information required.
03
Begin by providing your personal details, such as your name, address, and contact information.
04
In the next section, indicate the type of coverage you are declining for the 2018-19 period.
05
Provide any additional information or comments, if necessary.
06
Carefully review the filled-out form to ensure all the required fields are completed and accurate.
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Sign and date the form in the designated areas.
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Make a copy of the filled-out form for your records.
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Submit the completed declination of coverage form as per the instructions provided.

Who needs 2018-19 declination of coverage?

01
Anyone who wishes to decline coverage for the 2018-19 period needs to fill out the declination of coverage form.
02
This includes individuals who already have alternate coverage, such as through their employer or another insurance provider.
03
It is important to note that each individual's circumstances may vary, so it is advisable to consult with an insurance professional or legal advisor to determine if filling out the declination of coverage form is appropriate for your situation.
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19 declination of coverage is a form that employers must submit to declare that they are opting out of providing certain health insurance coverages required by law.
Employers who choose not to provide specific health insurance coverages as mandated must file the 19 declination of coverage.
To fill out the 19 declination of coverage, employers need to provide their business information, indicate the specific coverage being declined, and sign the form to confirm the declination.
The purpose of the 19 declination of coverage is to formally document an employer's choice to opt out of mandatory health insurance provisions, ensuring compliance with applicable regulations.
The information that must be reported includes the employer's name, address, details of the coverage being declined, and signatures of authorized representatives.
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