Affidavit group 2026

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  1. Click ‘Get Form’ to open the Affidavit of No Coverage by Another Group Health Plan in the editor.
  2. Begin by filling in the 'State' and 'County' fields at the top of the form. This information is essential for legal validity.
  3. In the section where it states 'Before me, the undersigned authority...', enter your name in the designated space.
  4. 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.
  5. Provide details about your previous group health plan by entering your former employer's name in the specified field.
  6. Finally, sign where indicated as 'Signature of former employee' and ensure to date it appropriately before submission.

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