Get the free 2015 Premium Spousal Surcharge Form - Human Resource Services - hrs wsu

Name Last four digits of SS Number: 2015 Premium Spousal Surcharge Form This form will be used during the 2014 November Open Enrollment period for employees who 1) are enrolled in a WEBB medical plan,

How to fill out 2015 premium spousal surcharge

How to fill out 2015 premium spousal surcharge:

1. Obtain the necessary forms: Start by acquiring the 2015 premium spousal surcharge form from the appropriate healthcare agency or insurance provider. This form is typically available online or can be obtained by contacting the agency directly.
2. Review the instructions: Carefully read through the instructions provided with the form. Make sure you understand the purpose of the premium spousal surcharge, the eligibility criteria, and the required documentation.
3. Fill in personal information: Begin filling out the form by entering your personal information, such as your name, address, Social Security number, and contact details. If applicable, provide the same information for your spouse.
4. Declare spousal coverage: Indicate whether you have health insurance coverage for your spouse. If you do, provide the necessary details, such as the insurance provider's name, policy number, and effective dates.
5. Calculate the surcharge amount: Calculate the premium spousal surcharge amount based on your spouse's coverage status. This typically involves multiplying a predetermined percentage by the total cost of your health insurance premium.
6. Make the payment: If you are liable for the premium spousal surcharge, ensure that you include the correct payment amount with your form. This can usually be done through a bank transfer, check, or an online payment system.
7. Submit the form: Once you have completed the form and attached any necessary documentation, submit it to the designated healthcare agency or insurance provider. It is advisable to keep a copy of the form and proof of submission for your records.

Who needs 2015 premium spousal surcharge:

1. Employees with healthcare coverage: The premium spousal surcharge is typically relevant for employees who have health insurance coverage through their employer.
2. Employees with an insured spouse: If you have health insurance coverage for yourself and your spouse is also insured under your policy, you may be required to pay the premium spousal surcharge.
3. Employers offering dependent coverage: Employers who offer dependent health insurance coverage to their employees may implement a premium spousal surcharge to account for the increased cost of providing coverage for a spouse who is already insured elsewhere.
4. Companies with spousal provisions: Some companies have specific provisions in their health insurance policy that require employees with a spouse eligible for coverage elsewhere to pay an additional fee, known as the premium spousal surcharge.

Overall, the 2015 premium spousal surcharge is applicable to individuals who have health insurance coverage for their spouse and are required to pay an additional fee to account for the cost of providing that coverage.

For pdfFiller’s FAQs

What is premium spousal surcharge form?

Premium spousal surcharge form is a form that allows an individual to report and pay an additional fee for their spouse's inclusion in a premium health insurance plan.

Who is required to file premium spousal surcharge form?

Individuals who have spouses that are eligible for health insurance coverage through their employer but choose to include them in their own employer-sponsored health plan may be required to file premium spousal surcharge form.

How to fill out premium spousal surcharge form?

To fill out premium spousal surcharge form, individuals need to provide information about their spouse's eligibility for other health insurance coverage, and calculate and pay the required surcharge amount.

What is the purpose of premium spousal surcharge form?

The purpose of premium spousal surcharge form is to ensure that individuals who have the option of enrolling their spouse in another health insurance plan contribute appropriately to the cost of their spouse's coverage.

What information must be reported on premium spousal surcharge form?

Information that must be reported on premium spousal surcharge form includes the spouse's eligibility for other health insurance coverage, the amount of surcharge to be paid, and any supporting documentation.

How do I modify my 2015 premium spousal surcharge in Gmail?

You may use pdfFiller's Gmail add-on to change, fill out, and eSign your 2015 premium spousal surcharge as well as other documents directly in your inbox by using the pdfFiller add-on for Gmail. pdfFiller for Gmail may be found on the Google Workspace Marketplace. Use the time you would have spent dealing with your papers and eSignatures for more vital tasks instead.

How do I make changes in 2015 premium spousal surcharge?

pdfFiller not only lets you change the content of your files, but you can also change the number and order of pages. Upload your 2015 premium spousal surcharge to the editor and make any changes in a few clicks. The editor lets you black out, type, and erase text in PDFs. You can also add images, sticky notes, and text boxes, as well as many other things.

How do I fill out 2015 premium spousal surcharge on an Android device?

Use the pdfFiller mobile app and complete your 2015 premium spousal surcharge and other documents on your Android device. The app provides you with all essential document management features, such as editing content, eSigning, annotating, sharing files, etc. You will have access to your documents at any time, as long as there is an internet connection.