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IDear Workforce-I Form to Decline Coverage

There isn't a form used as a standard.
February 20, 2000
Related Topics: Medical Benefits Law, Dear Workforce, Benefits

Dear Workforce:

Hi! Maybe you can help me. Is there a standard form employees fill out when they decline coverage?




Dear Susan:

There is no standard form; the only language that is becoming "standardized" involves pre-tax employee contributions wherein the employee acknowledges that their election is valid for an entire plan year unless there are specific changes in status as defined in the regulations.

This would be relevant when someone declines coverage under a flex scenario. Even outside a flex situation, an employer would not want to allow people to change their minds and enroll before the next enrollment period to control their anti-selection claims costs (insurers provide likewise). So, standard language should reflect an election for the plan year unless specific status changes occur as specified by the insurer or the plan sponsor.


SOURCE: Werner Gliebe, a senior consultant in the corporate practice of the Segal Company. Gliebe works out of New York and Cleveland.

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 The information contained in this article is intended to provide useful information on the topic covered, but should not be construed as legal advice or a legal opinion. Also remember that state laws may differ from the federal law.

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