Insurance Waiver Template

About this template

An insurance waiver is a legal document signed by an employee declining any offered health insurance coverage. With our free Insurance Waiver Template, you can securely collect e-signatures from employees who have chosen to opt out of your company’s health insurance plan. Simply share this form with signers via email and automatically receive the finalized document once it’s filled out and signed.

Customize the look and feel of this Insurance Waiver template in seconds with Jotform’s no-code builder. Drag and drop to add your company’s branding, edit the declaration of waiver wording, include dropdown and multiple choice fields, and more. Once your custom insurance waiver has been signed and instantly sent back to you, you can then print or save the finalized document for your records. Collect e-signatures on any device with Jotform Sign.

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The e-sign templates here are for informational purposes only. Jotform is not providing legal, financial, or other advice, or implying that the forms are legally valid in all or any jurisdictions. Before using any such template, consult an attorney and/or other applicable professionals to make sure that the form meets your needs, legally and otherwise.