Menard County, TX · Menard County
Acknowledgement of Receipt of Health Plan Notices
Menard County employees sign this acknowledgment to confirm receipt of notices included with the county’s 2025 employee insurance benefits information.
At a glance
- Issued by
- City of Menard County · Menard County, Menard County, Texas
- Notarization
- Not required: file this form without a notary.
- Official source
- co.menard.tx.us
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This acknowledgment records an employee’s receipt of health plan notices listed in the document, including the Summary of Benefits & Coverage, privacy notice, and COBRA notice. It appears with Menard County employee insurance benefits information effective January 1 through December 31, 2025. The acknowledgment asks the employee to sign, date, and print their name; no submission instructions are stated.
Who needs it
Menard County employees receiving the listed health plan notices can use the acknowledgment to record receipt by signing, dating, and printing their name.
How to submit it
Submit it to the county office named on the form; check the county website for current contact details.
About notarization
This document is signed without a notary; the signer just signs and dates the acknowledgment.
How to submit this form
- 1
Download the Acknowledgment
Download the health plan notices acknowledgment from the county document.
- 2
Complete the Acknowledgment
Print your name, sign, and date the acknowledgment.
- 3
Check for Attachments
The document does not list attachments required for the acknowledgment.
- 4
Submit to the County
The document gives no submission instructions; check the county website for current contact details.
Frequently asked questions
- What does the health plan notices acknowledgment confirm?
- It records receipt of notices listed in Menard County’s employee insurance benefits information, including the Summary of Benefits & Coverage and privacy notice.
- Who completes this acknowledgment?
- Menard County employees receiving the listed health plan notices complete it by printing their name and signing and dating the acknowledgment.
- Do I need a notary for the health plan notices acknowledgment?
- No. This document is signed without a notary; the signer just signs and dates the acknowledgment.
- How do I submit the health plan notices acknowledgment?
- The document does not state how to submit it. Submit it to the county office named on the form; check the county website for current contact details.