Job Update Form PDF Details

In today’s ever-changing employment landscape, staying updated with your job status is not just recommended; it's often required, especially when it pertains to benefits that are tied to your employment situation. The Job Update form serves a crucial role for individuals who are participants in MassHealth, allowing them to report any new job acquisitions or changes in their current job situation accurately. This document is meticulously designed to gather comprehensive employment-related information, including but not limited to an individual's employer details, wage or salary before taxes, working hours, seasonal employment status, and the availablity of health insurance through employment. It also inquires about self-employment and asks for specifics about net income post-business expenses. Completing all sections, providing a signature along with the date, and attaching relevant proof of income or changes therein are imperative steps to ensure continuous coverage or benefits. The form’s structured layout, encompassing sections from employment details to health insurance information, underscores the importance of detailed communication between employees and health benefit administrators, thereby safeguarding against any potential interruption in benefits due to job changes.

QuestionAnswer
Form NameJob Update Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmasshealth 1 form, you masshealth 1 pdf, health masshealth form make, masshealth employment form online

Form Preview Example

Job Update

This form is used to tell MassHealth about a new job or a change in your job.

Please enter your name and social security number (SSN) or MassHealth ID directly below.You must complete all sections.Sign and date the form.

Employee Name

 

Employee SSN/MassHealth ID

 

Section A. Current Job Information (You must complete this section.)

I am currently working (fill out the following section(s)) 1. Current Job 1

Name of employer

Address of employer

a. Wages/tips (before taxes) $

 

 

 

Weekly

 

Every two weeks

 

 

 

 

 

 

 

(Subtract any pre-tax deductions, such as non-taxable health insurance premiums.) b. How many hours a week do you work?

c. Are you seasonally employed?

 

yes

 

no

If yes, how many months do you work each calendar year?

Twice a month

Monthly

Yearly

d. Are you self-employed?

yes

no

e.If yes, how much net income (proits after business expenses are paid) will you get from this self-employment each month?

$

f.Is this job a sheltered workshop?

yes

no

g. Is health insurance ofered that would cover doctors’ visits and hospitalizations? (Answer yes even if you cannot get it now,

chose not to sign up for it, or dropped insurance that was available.)

yes

no

 

 

If you answered no to the last question, was health insurance ofered in the last six months?

yes

no

2.Current Job 2 (If you have more jobs and need more space, attach another sheet of paper.)

Name of employer

Address of employer

a.

Wages/tips (before taxes) $

 

 

 

 

Weekly

Every two weeks

Twice a month

Monthly

Yearly

 

(Subtract any pre-tax deductions, such as non-taxable health insurance premiums.)

 

 

 

b.

How many hours a week do you work?

 

 

 

 

 

 

 

c.

Are you seasonally employed?

yes

no

 

 

 

 

If yes, how many months do you work each calendar year?

d. Are you self-employed?

yes

no

e.If yes, how much net income (proits after business expenses are paid) will you get from this self-employment each month?

$

f.Is this job a sheltered workshop?

yes

no

g. Is health insurance ofered that would cover doctors’ visits and hospitalizations? (Answer yes even if you cannot get it now,

chose not to sign up for it, or dropped insurance that was available.)

yes

no

 

 

If you answered no to the last question, was health insurance ofered in the last six months?

yes

no

You must send us two recent pay stubs or other proof of income along with this filled-out and signed form, OR your family’s MassHealth or Health Safety Net (HSN) benefits will stop.

I recently stopped working (within the last six months). When did you stop working?

I am receiving unemployment benefits. Send a copy of a recent check showing gross unemployment income. I have not worked within the last six months.

JU-1 (01/16)

1

Job Update

Employee Name

 

Employee SSN/MassHealth ID

Section B. Yearly Income Information (You must complete this section.)

1.What is your total expected income for the current calendar year? $

2.What is your total expected income for next calendar year, if diferent? $

Section C. Health Insurance (You must complete this section.)

1. Are you and/or members of your family currently enrolled in health insurance from your job?

yes

no

If yes, please ill out the section below and send us a copy of both sides of the health insurance card(s).

a.Insurance company name

b.Names of covered family members

c.Policy number

d.

Is this COBRA coverage?

yes

no

e.

Is this a retiree health plan?

yes

no

Section D. Signature (You must complete this section.)

I certify under the pains and penalty of perjury that what is stated on this form is correct and complete to the best of my knowledge.

Signature of working person or authorized representative

Date

Return this completed, signed form and proof of current income to

Health Insurance Processing Center

P.O. Box 4405

Taunton, MA 02780

JU-1 (01/16)

2

Job Update

How to Edit Job Update Form Online for Free

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Step 1: Simply press the "Get Form Button" in the top section of this site to launch our form editing tool. This way, you'll find everything that is needed to work with your document.

Step 2: Once you launch the online editor, you'll notice the document prepared to be filled in. Besides filling out various blank fields, it's also possible to do other sorts of actions with the Document, specifically putting on your own textual content, editing the original text, inserting illustrations or photos, putting your signature on the PDF, and a lot more.

This PDF will require particular data to be filled in, therefore be sure you take whatever time to fill in exactly what is expected:

1. Firstly, once completing the must masshealth form, start with the area containing next blank fields:

health masshealth form get writing process described (step 1)

2. After the last array of fields is complete, you're ready add the needed specifics in Current Job If you have more, Name of employer Address of, yes, Every two weeks Subtract any, Weekly, Twice a month, Monthly, Yearly, If yes how many months do you work, If yes how much net income proits, yes, yes, yes, You must send us two recent pay, and When did you stop working so that you can progress to the next step.

Stage no. 2 of filling in health masshealth form get

3. Completing I am receiving unemployment, and Job Update is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

health masshealth form get conclusion process clarified (stage 3)

Regarding Job Update and I am receiving unemployment, be sure you do everything properly here. Both of these are the most significant fields in the PDF.

4. This next section requires some additional information. Ensure you complete all the necessary fields - Employee Name, Employee SSNMassHealth ID, Section B Yearly Income, What is your total expected, Section C Health Insurance You, Are you andor members of your, no If yes please ill out the, yes, Insurance company name, a b Names of covered family, Is this COBRA coverage Is this a, yes, yes, Section D Signature You must, and I certify under the pains and - to proceed further in your process!

Section D Signature You must, yes, and What is your total expected inside health masshealth form get

Step 3: You should make sure the details are right and press "Done" to complete the project. Obtain the must masshealth form once you subscribe to a 7-day free trial. Instantly gain access to the pdf file from your personal account, along with any modifications and changes being all synced! We do not share any information that you type in whenever filling out documents at our website.

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