Broward Florida Affidavit of No Coverage by Another Group Health Plan

State:
Multi-State
County:
Broward
Control #:
US-321EM
Format:
Word; 
Rich Text
Instant download

Description

The employee named in this affidavit attests to the fact that he or she is not covered by any other group health plan.

The Broward Florida Affidavit of No Coverage by Another Group Health Plan is a legal document typically used in the state of Florida to verify that an individual does not have coverage under any other group health plan. This affidavit is primarily required when an individual is applying for coverage under a new group health plan and needs to establish that they are not already enrolled in another plan. Keywords: Broward Florida Affidavit, Group Health Plan, No Coverage, Coverage Verification, Affidavit of No Coverage, Florida Healthcare, Insurance Eligibility, Broward County, Medical Coverage Types of Broward Florida Affidavits of No Coverage: 1. Individual Affidavit of No Coverage: This type of affidavit is completed by an individual who is applying for coverage under a group health plan. It states that the individual does not currently hold coverage under any other group health plan. 2. Family Affidavit of No Coverage: If a family is applying for coverage under a group health plan, each family member may need to complete a separate affidavit. Each affidavit verifies that the respective family member has no coverage under any other group health plan. 3. Spousal Affidavit of No Coverage: In cases where one spouse is already covered under a group health plan, the other spouse may need to provide an affidavit to confirm that they do not have coverage through their partner's plan. 4. Dependent Affidavit of No Coverage: This type of affidavit is completed by a dependent who is applying for coverage under a parent's group health plan. It affirms that the dependent is not covered under any other group health plan, separate from the parent's plan. It's important to note that the above types of affidavits may vary slightly depending on the specific requirements set by the Broward County jurisdiction or the group health plan provider. Furthermore, it is advisable to consult with a legal professional or contact the relevant insurance or healthcare authority to ensure compliance with the correct affidavit format.

How to fill out Broward Florida Affidavit Of No Coverage By Another Group Health Plan?

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FAQ

Certificates of coverage are written documents provided by a group health plan (or another source that offers health care coverage) to show the type of health care coverage a person had (e.g., employee only, family, etc.) and how long the coverage lasted.

Continuation coverage allows someone who recently lost their employer-based health coverage to continue their current insurance policy as long as they pay the full monthly premiums. Continuation coverage falls into four categories: COBRA, Cal-COBRA, Conversion, and HIPAA.

In the private sector it's called COBRA. In the federal government it's called Temporary Continuation of Coverage. In both cases it's a way to remain in an employer-sponsored health insurance program when you leave that employer for a time, although at a higher cost.

A certificate of coverage is an official form issued by the Social Security Administration (SSA) or an authorized agency of an agreement country to certify that the employee named on the form is subject to Social Security coverage in the issuing country and exempt from coverage in the other country.

HIPAA creditable coverage -- The concept of HIPAA creditable coverage is that an individual should be given day-for-day credit for previous health coverage against the application of a preexisting condition exclusion period when moving from one group health plan to another, from a group health plan to individual

This document explains the health benefits you and your dependents have under the plan. It details the services that will and will not be covered. Services that are not covered are called exclusions.

This certificate provides evidence of your prior health coverage. You may need to furnish this certificate if you become eligible under a group health plan that excludes coverage for certain medical conditions that you have before you enroll.

You can usually only add a spouse and any eligible children to a healthcare plan. Even if a parent is a tax dependent and lives with you, you typically won't be able to add them to your health coverage.

COBRA continuation coverage gives Florida workers and families who lose their employer-sponsored health insurance benefits the right to choose to continue their group health plan for a limited period of time, under certain circumstances, such as job loss, a reduction in hours worked, divorce, and other ?qualifying

Florida's state continuation or ?mini-COBRA? law provides similar continuation of coverage protection for employees who work for employers with two to 19 employees. Once you elect mini-COBRA coverage, you will pay 100% of the total insurance premium plus a 15% processing fee.

More info

This guide contains information to help you administer your group health care Coverage program. Without medical insurance how can I get my children immunized?You need to learn the full extent of insurance coverage to maximize your potential recovery. Group health coverage for up to 18 months from the date employment terminates or until the employee is covered under another group plan, whichever is first. Declination of Medical Coverage OptOut Program . Package 1(c) Constructive Service. What this package contains: ❑ Notice of Action for Dissolution of Marriage. Broward County Property Appraiser - Marty Kiar. Welcome to the Extranet Portal for Retirees of the IDB Group!

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Broward Florida Affidavit of No Coverage by Another Group Health Plan