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Doh 116m form 2026
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- Click ‘Get Form’ to open the doh 116m form in the editor.
- Begin by filling out the 'Employee Information' section. Enter the employee's name and Social Security Number (SSN) accurately.
- 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.
- Proceed to answer the questions regarding health insurance offerings. Select 'Yes' or 'No' for each question and provide additional information where required.
- 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.
- 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.
- Finally, ensure that a representative from Human Resources signs and dates the form before submission.
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