Utah form 116m 2026

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The document is a health insurance information form (DOH Form 116M) that must be completed by an employer or HR representative for each employed household member. It collects details about the employee's health insurance coverage, eligibility, and costs associated with the employer's health plans. The form includes sections for general information, employer's least expensive plan, employee's health plan choice, and requires a signature from an HR representative to certify the accuracy of the provided information.

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Click ‘Get Form’ to open Utah Form 116M in our editor.
Begin by filling out the 'General Information' section. Enter the employee's name and Social Security Number, followed by the employer's name, EIN, phone number, and address.
In the next part, answer questions regarding health insurance availability. Ensure to check 'Yes' or 'No' for each question and provide additional details where necessary.
Proceed to Section B, which focuses on the employer's least expensive plan. Fill in details about enrollment requirements and coverage start dates.
In Section C, provide information about the employee's selected health plan. Answer questions related to deductibles and benefits covered under the plan.
Finally, complete Section D by signing and dating the form. Ensure that all information is accurate before submission.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (193 Votes)
2019	4.3 Satisfied (46 Votes)
2014	4.2 Satisfied (57 Votes)

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Home / Blogs / Do I Have to Take Health Insurance from My Job? The short answer is no, you dont have to enroll in your employers health insurance coverage.

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What is the 116M form?

The DOH Form 116M is a detailed document from the State of Utah Department of Health, designed for employers to provide comprehensive information about the health insurance options available to their employees.

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Utah form 116m 2026

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How to use or fill out Utah Form 116M with DocHub

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Complete this form in 5 minutes or less

Got questions?

Do I have to accept my employers health insurance?

How to file an annual report for LLC in Utah?

What is the 116M form?

What is the income limit for Utah Medicaid?

What information is needed to complete a claim form?

Security and compliance

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What is the health insurance claim form used for?

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