Doh 116m form 2026

1. Click ‘Get Form’ to open the doh 116m form in the editor.
2. Begin by filling out the 'Employee Information' section. Enter the employee's name and Social Security Number (SSN) accurately.
3. In the 'Employer Information' section, provide details such as the employer's name, EIN, phone number, and address. Ensure all fields are completed to avoid delays.
4. Proceed to answer the questions regarding health insurance offerings. Select 'Yes' or 'No' for each question and provide additional information where required.
5. Complete Section B by detailing the employer’s least expensive plan or Avenue H Default Plan. Fill in premium amounts and deductible information as applicable.
6. In Section C, specify the employee’s chosen health plan details including insurance company name and policy number. Answer questions about coverage limits and benefits.
7. Finally, ensure that a representative from Human Resources signs and dates the form before submission.

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