271. Form IB16 Retiree Employment Verification - Alabama
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 si ...
272. Form IB15 Retired State Employee Plan Change Form - Alabama
INSTRUCTIONS: ALABAMA RETIRED EMPLOYEE PLAN CHANGE FORM (Form IB15) Retired Alabama employees of the state can change their health insurance coverage by filing a form IB15. This document can be obtained from the website maintained ...
273. Form IB10 Refund Request - Alabama
INSTRUCTIONS: ALABAMA REFUND REQUEST (Form IB10) Alabama public agencies and public employees can request a refund of employees' state health insurance premiums by filing form IB10. This document can be obtained from ...
274. Form IB14 State Employee Plan Change Form - Alabama
INSTRUCTIONS: ALABAMA STATE EMPLOYEE PLAN CHANGE FORM (Form IB14) Alabama state employees who wish to change their health insurance coverage do so by filing a form IB14. This form can be obtained from the website of the Alabama Sta ...
275. Form IB09 Revoke Election Form - Alabama
INSTRUCTIONS: ALABAMA REVOKE ELECTION FORM (Form IB09) To revoke the election of dependent coverage due to a change in status as an Alabama state employee, a form IB09 should be filed. This document is not applicable to ...
276. Federal Poverty Level (FPL) Discount Application - Alabama
INSTRUCTIONS: ALABAMA FEDERAL POVERTY LEVEL (FPL) DISCOUNT APPLICATION (Form IB12) To apply for a discount on Alabama state employees' insurance on the basis of being at or below the federal poverty level, file a for ...
277. Form 1B08 New Employee Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan - Alabama
INSTRUCTIONS: ALABAMA NEW EMPLOYEE — OPEN ENROLLMENT SALARY REDUCTION AGREEMENT DEPENDENT PREMIUM CONVERSION PLAN (Form IB08) Alabama state employees use form IB08 to enroll in or opt out of the Dependent Premium C ...
278. Form IB11 COBRA Employer Notice Memo - Alabama
INSTRUCTIONS: ALABAMA COBRA EMPLOYER NOTICE MEMO (Form IB11) Alabama state employers notify the State Employees' Insurance Board of various changes in the status of an employee under the provisions of COBRA who is en ...
279. Form IB07 Wellness Discount Certification Form - Alabama
INSTRUCTIONS: ALABAMA STATE EMPLOYEES' HEALTH INSURANCE PLAN WELLNESS DISCOUNT CERTIFICATION FORM (Form IB07) Alabama state employees use form IB07 to obtain a wellness discount certification after participating in a ...
280. Form IB13 Provider Screening Form - Alabama
INSTRUCTIONS: ALABAMA STATE EMPLOYEES' HEALTH INSURANCE PLAN PROVIDER SCREENING PLAN (Form IB13) Alabama state employees who cannot or choose not to participate in the state employees' insurance board Worksite We ...