BIAW MBA NMTA CAMPS BIIT WAIVER RELEASE & CANCELLATION REQUEST 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with SECTION 1. Indicate your reason for waiving coverage by selecting either 'CANCEL EXISTING GROUP COVERAGE' or 'INITIAL/NEW HIRE WAIVER OF INSURANCE'. Fill in the respective cancellation or hire date.
  3. Move to SECTION 2. Here, specify your current coverage source if opting out of your Employer’s insurance plan. Choose from options like Medicare, Military, Spouse, etc., and provide the Insurance Carrier and Group Number if applicable.
  4. In SECTION 3, complete the Employee Certification & Acknowledgment. Print your name, date of birth, and Social Security number. Ensure you understand the implications of waiving coverage and sign where indicated.
  5. Finally, review all sections for completeness before submitting. Incomplete forms will be returned.

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