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1. Parties: Identification of the individual waiving coverage (the 'Waiver') and the organization/employer offering the health insurance (the 'Provider')
2. Background: Context explaining the health insurance offering and the option to waive coverage
3. Definitions: Key terms used throughout the waiver document
4. Acknowledgment of Alternative Coverage: Declaration that the individual has alternative health insurance coverage, including details of the alternative coverage
5. Benefits Being Waived: Specific description of the health insurance benefits being voluntarily waived
6. Voluntary Waiver Declaration: Statement confirming that the waiver is being made voluntarily and with full understanding
7. Risk Acknowledgment: Recognition of potential risks and consequences of waiving health insurance coverage
8. Duration of Waiver: Period for which the waiver will be in effect
9. Reinstatement Rights: Conditions under which the individual can reinstate coverage in the future
10. Release of Liability: Release of the provider from liability related to the waived coverage
11. Governing Law: Specification that the waiver is governed by applicable Canadian and provincial laws
12. Execution: Signature block, witnessing requirements, and date of execution
1. Spouse/Dependent Acknowledgment: Required when the waiver affects coverage for spouse or dependents
2. Premium Reduction Agreement: Used when waiving coverage results in adjustment to employee compensation or benefits
3. Special Circumstances: Required for temporary waivers or specific situations (e.g., sabbatical, temporary foreign assignment)
4. Group Benefits Continuation: Used when partial waiver allows continuation of certain group benefits
5. Provincial Specific Requirements: Additional provisions required by specific provincial legislation
6. Union Agreement Reference: Required when the waiver must align with collective bargaining agreements
1. Schedule A - Alternative Coverage Details: Detailed information about the alternative health insurance coverage
2. Schedule B - Waived Benefits Summary: Comprehensive list and description of all benefits being waived
3. Schedule C - Reinstatement Procedures: Detailed procedures and requirements for reinstating coverage
4. Appendix 1 - Provincial Health Insurance Information: Reference information about provincial health coverage
5. Appendix 2 - Frequently Asked Questions: Common questions and answers about the implications of waiving coverage
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