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State of New Jersey Department of the Treasury FN03910923DIVISION OF PENSIONS & BENEFITS TAX$AVE P.O. Box 295, Trenton, NJ 086250295DECLINATION OF PREMIUM OPTION PLAN (POP) FOR PLAN YEAR 2024 If you

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How to fill out declination of premium option

01

Obtain the declination of premium option form from your insurance company.

02

Fill in your personal details such as name, policy number, and contact information.

03

Select the reason for choosing the declination of premium option.

04

Sign and date the form to acknowledge your decision.

05

Submit the completed form to your insurance company for processing.

Who needs declination of premium option?

01

Individuals who want to opt out of paying for a premium in their insurance policy.

02

People who are not interested in the benefits offered by the premium option.

03

Customers who have alternative coverage and do not require the additional services provided by the premium.

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What is declination of premium option?

Declination of premium option is when an individual chooses to opt out of premium payment for a certain type of insurance coverage.

Who is required to file declination of premium option?

Individuals who wish to opt out of premium payment for a specific insurance coverage are required to file declination of premium option form.

How to fill out declination of premium option?

To fill out declination of premium option, individuals need to provide their personal information, insurance policy details, and reason for opting out of premium payment.

What is the purpose of declination of premium option?

The purpose of declination of premium option is to allow individuals to choose whether they want to pay premium for a specific insurance coverage or not.

What information must be reported on declination of premium option?

The information required on declination of premium option includes personal details, insurance policy information, and reason for opting out of premium payment.

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