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Affidavit group 2026
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- Click ‘Get Form’ to open the Affidavit of No Coverage by Another Group Health Plan in the editor.
- Begin by filling in the 'State' and 'County' fields at the top of the form. This information is essential for legal validity.
- In the section where it states 'Before me, the undersigned authority...', enter your name in the designated space.
- Complete the statement regarding your age and legal status by filling in your name again in the first blank and confirming you are over 18 years old.
- Provide details about your previous group health plan by entering your former employer's name in the specified field.
- Finally, sign where indicated as 'Signature of former employee' and ensure to date it appropriately before submission.
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