Form 2 – Employer Questionnaire from the MPI website.
This form must be filled out by those who want to cover their spouse or same-sex domestic partner in the MPI Health Plan
This form is to be filled out by your spouse or same-sex domestic partner’s employer. This form is to provide documentation from your spouse/parter’s employer that states that there is or is not health plan coverage available, and if there is, whether your spouse/partner has or has not elected to take the coverage offered.
This form should be given to the appropriate person at your spouse/partner’s employment to be filled out and returned to them.
* Click the image for a larger view but access the form using the link above.