SOH-XDP100M-NW 2026

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4.5 out of 5

40 votes

The document provides detailed instructions for completing the Statement of Health and Authorization forms required for group insurance coverage through MetLife. It outlines the responsibilities of the Recordkeeper, Employee, and Proposed Insured, including necessary information to be filled out, submission guidelines, and potential follow-up requirements. Additionally, it includes health-related questions that must be answered by the Proposed Insured and emphasizes the importance of accuracy to avoid delays in processing. The document also contains fraud warnings specific to various states and outlines the authorization process for sharing medical information.

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Click ‘Get Form’ to open the SOH-XDP100M-NW in the editor.
Begin by filling in the Group Customer Information and Insurance Information sections as instructed. Ensure all fields are completed accurately.
As the Employee, enter your name and Social Security number on the Statement of Health form. This information is crucial for identification.
The Proposed Insured must complete their section, including personal details such as name, address, date of birth, and relationship to the Employee.
In the Health Information section, answer all questions truthfully. If any question requires a 'yes' answer, provide detailed information in Section 2.
Complete the Personal Physician and Prescription Information sections if applicable. Make sure to include all prescribed medications.
Finally, sign both the Statement of Health and Authorization forms where indicated. Review all entries for accuracy before submission.

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Versions	Form popularity	Fillable & printable
2017	4.9 Satisfied (45 Votes)
2016	4.5 Satisfied (40 Votes)

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How to calculate the soh?

The formula is defined as follows: SOH = C C C I 100 % where CC indicates the maximum available capacity of the current cycle and CI indicates the maximum available capacity of the initial cycle.