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Spouse attestation form pdf 2025

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The document is a Spousal Employer Medical Coverage Attestation Form for the Westlake Health Care Plan. It outlines the process for employees to apply for a waiver of a monthly spousal surcharge if their spouse has access to medical coverage through their own employer. Employees must provide personal information, certify the accuracy of their statements, and understand that waivers expire at the end of each enrollment period. Additionally, the form requires verification from the spouse's employer regarding their access to medical coverage.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a spouse attestation?

To enroll your spouse in the SAG-AFTRA Health Plan, you need to complete a spouse coverage attestation when you qualify for your next annual benefit period. This is required it establishes your spouses eligibility for benefits.

How to avoid spousal surcharge for insurance?

To avoid paying the surcharge, your spouse or partner can enroll in his or her employers medical plan. Youll want to compare coverage and total costs both ways to see what makes sense for your family.

What is the spouse partner attestation form?

Complete your working-spouse attestation To enroll your spouse in the SAG-AFTRA Health Plan, you need to complete a spouse coverage attestation when you qualify for your next annual benefit period. This is required it establishes your spouses eligibility for benefits.

What is spousal attestation health insurance?

A spousal surcharge is an additional fee on a medical plan if an employees spouse is eligible for health insurance through their own employer on their own plan. This surcharge is a method used to help control employer costs.

What is a spousal attestation?

The Medical Plan Affidavit will require the spouse to indicate if they are employed. If the spouse is employed, the spouses employer will be required to complete the Medical Plan Affidavit to confirm that the spouse is not eligible for group medical coverage with their employer.

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