INSTRUCTIONS: ALABAMA RETIREE EMPLOYMENT VERIFICATION FORM (Form IB16)

Alabama state employees who retired following September 30, 2005 and obtained employment with an employer who provides at least 50% of the cost of single health insurance coverage can re-enroll in the the State Employees' Health Insurance Plan if their employer stops paying at least 50% of this cost. This is done using the form discussed in this article, which can be obtained from the website maintained by the Alabama State Employees' Insurance Board.

Alabama Retiree Employment Verification Form IB16 Step 1: On line 1, indicate whether you are employed by checking "Yes" or "No." If no, you do not need to answer the remaining questions. Sign and return the form.

Alabama Retiree Employment Verification Form IB16 Step 2: If employed, enter the name of your employer on the first blank line.

Alabama Retiree Employment Verification Form IB16 Step 3: If employed, enter your employer's street address on the second blank line.

Alabama Retiree Employment Verification Form IB16 Step 4: If employed, enter your employer's city, state and zip code on the third blank line.

Alabama Retiree Employment Verification Form IB16 Step 5: If employed enter your employer's telephone number, including the area code, on the fourth blank line.

Alabama Retiree Employment Verification Form IB16 Step 6: If employed, give your hire date on the fifth blank line.

Alabama Retiree Employment Verification Form IB16 Step 7: On line 2, indicate whether your employer offers group health insurance by checking "Yes" or "No" as applicable. If no, skip the remaining questions and sign and return the form.

Alabama Retiree Employment Verification Form IB16 Step 8: On line 3, indicate whether your employer contributes at least 50% or more of the cost of single health insurance coverage for its employees by checking "Yes" or "No" as applicable. If no, skip the next question, then sign and return the form.

Alabama Retiree Employment Verification Form IB16 Step 9: On line 4, indicate whether you are eligible for your employer's group health insurance coverage by checking "Yes" or "No" as applicable. If no, provide a written explanation.

Alabama Retiree Employment Verification Form IB16 Step 10: Enter your signature on the next blank line.

Alabama Retiree Employment Verification Form IB16 Step 11: Enter the date on the last blank line.