Waiver for Less Than Full Year. If I drop healthcare coverage before the 1st of any month, I will be credited with a full month for purposes of the waiver. I will thereinafter receive 1/12 of the appropriate waiver sum for each month I waive healthcare coverage. Payment will be made in the last paycheck issued in July and any remainder due me as a result of my healthcare waiver for previous months shall be paid to me in the last paycheck issued in the following January. Date: Employee Signature Employee – Print Full Name
Waiver for Less Than Full Year. If I drop health insurance before the 1st of any month, I will be credited with a full month for purposes of the waiver beginning with the next full month following notification. I will thereinafter receive 1/12th of the appropriate waiver sum for each full month I waive health insurance. Payments shall be made on or about May 1st of each year. This waiver will remain in effect until a change is requested, in writing, or my full time appointment is terminated. Date Signature M E M O R A N D U M S O F
