Utah Employees Notification of Intent To Leave Locality Or State And To Change Doctor Or Hospital

• Category: Utah Workers Compensation - Official
• State: Utah
• Control #: UT-SKU-0692
• Format: PDF

Description

Employees Notification of Intent To Leave Locality Or State And To Change Doctor Or Hospital Utah Employees Notification of Intent To Leave Locality Or State And To Change Doctor Or Hospital is a legal form that must be completed by an employee of a Utah-based employer who intends to move out of their current locality or state. The form must be completed and submitted to the employer in order to apply for a change in health insurance coverage. The form must also be completed and submitted to the new doctor or hospital in order to receive coverage in the new location. Types of Utah Employees Notification of Intent To Leave Locality Or State And To Change Doctor Or Hospital include: 1. Notification of Change in Health Insurance: This form must be completed by the employee in order to inform the employer of the intended change in health insurance coverage. It includes information such as the date of the move, the current and new locality or state, and the names of the current and new doctor or hospital. 2. Notification of Change in Doctor or Hospital: This form must be completed and submitted to the new doctor or hospital in order to receive coverage in the new location. It includes information such as the employee’s name, current and new locality or state, and the names of the current and new doctor or hospital. 3. Notification of Change in Employment Status: This form must be completed by the employee in order to inform the employer of the intended change in employment status. It includes information such as the date of the move, the current and new locality or state, and the names of the current and new employer.

Utah Employees Notification of Intent To Leave Locality Or State And To Change Doctor Or Hospital is a legal form that must be completed by an employee of a Utah-based employer who intends to move out of their current locality or state. The form must be completed and submitted to the employer in order to apply for a change in health insurance coverage. The form must also be completed and submitted to the new doctor or hospital in order to receive coverage in the new location. Types of Utah Employees Notification of Intent To Leave Locality Or State And To Change Doctor Or Hospital include: 1. Notification of Change in Health Insurance: This form must be completed by the employee in order to inform the employer of the intended change in health insurance coverage. It includes information such as the date of the move, the current and new locality or state, and the names of the current and new doctor or hospital. 2. Notification of Change in Doctor or Hospital: This form must be completed and submitted to the new doctor or hospital in order to receive coverage in the new location. It includes information such as the employee’s name, current and new locality or state, and the names of the current and new doctor or hospital. 3. Notification of Change in Employment Status: This form must be completed by the employee in order to inform the employer of the intended change in employment status. It includes information such as the date of the move, the current and new locality or state, and the names of the current and new employer.