Employee Insurance Waiver Form
Employee Insurance Waiver Form
Please provide all the necessary information below.
Company Name
Employee Name
Employee ID
Date of Employment
Position/Department
Reason
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I am covered by an alternative health insurance plan.
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I prefer not to participate in the company’s insurance plan at this time.
Acknowledgment of Waiver
I hereby acknowledge that I have been offered insurance coverage by [Your Company Name] as part of the employee benefits package. I understand that by signing this waiver, I am choosing to decline this insurance coverage.
Name:
Date:
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