Form 116m 2026

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4.8 out of 5

193 votes

The document is a form from the State of Utah's Department of Health, titled 'Employer's Health Insurance Information.' It is designed for employers to provide details about health insurance offerings for their employees. The form requires information on whether the company offers health insurance, enrollment periods, coverage specifics, and costs associated with various health plans. It also includes sections for employees not enrolled in a plan and requires signatures for submission.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the employee’s name, SSN (optional), and employer name in the designated fields.
Answer whether your company offers health insurance. If 'No', proceed to Section E.
Fill in the enrollment period start date and confirm if your company offers a qualified health plan by checking the appropriate boxes.
In Section B, complete the chart detailing the least expensive plan for each coverage type, including monthly premiums and deductibles.
If applicable, provide information about any existing health plans in Section D, including names of enrolled individuals and policy details.
Finally, sign and date the form in Section E before submitting it as instructed.

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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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utah 116m form

Form 116m printable Form 116m pdf Form 116m template Form 116m instructions Form 116M Utah How to fill out form 116m Form 630 Utah 630 employment information form

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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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Form 116m 2026

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Got questions?

How to fill out a DA31 form?

What information is needed to complete a claim form?

What is the health insurance claim form used for?

How to fill out an AW-9 form?

Do I have to accept my employers health insurance?

Security and compliance

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What is the 116M form?

What is a DE 1545 form?

utah form 116m

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