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This form is used for enrollment in the Kaiser Permanente Student Health Plan during the academic year and for making changes to existing coverage, including adding dependents or updating information.
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How to fill out kaiser permanente student health
How to fill out Kaiser Permanente Student Health Plan Enrollment/Change Form
01
Obtain the Kaiser Permanente Student Health Plan Enrollment/Change Form from your campus health office or the Kaiser Permanente website.
02
Review the form to understand the information required, including personal details, student status, and coverage options.
03
Fill in your personal information such as name, student ID, date of birth, and contact details in the designated sections.
04
Indicate whether you are enrolling in the health plan for the first time or making changes to an existing plan.
05
Select the appropriate coverage option based on your needs (individual, family, etc.).
06
If needed, provide information about any existing health coverage you might have.
07
Review all the information for accuracy and completeness before signing the form.
08
Submit the completed form to your campus health office or directly to Kaiser Permanente as instructed.
Who needs Kaiser Permanente Student Health Plan Enrollment/Change Form?
01
Any student wishing to enroll in a health plan for the first time.
02
Students needing to make changes to their existing health plan coverage.
03
Individuals who are required to provide proof of health insurance for enrollment in a college or university.
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People Also Ask about
How to change name on Kaiser account online?
To update the spelling of your legal name, contact Member Services at 800-464-4000. Currently, our My Doctor Online app displays your legal name. You may be able to add your preferred name in a future enhancement.
Does Kaiser have a cancellation fee?
If you miss an appointment, or do not cancel your appointment within a reasonable amount of time, we might charge you a cancellation fee, depending upon the type of service. Your insurance will not pay these fees. They are your responsibility and will be billed directly to you.
Does Kaiser charge for cancellation?
If you miss an appointment, or do not cancel your appointment within a reasonable amount of time, we might charge you a cancellation fee, depending upon the type of service. Your insurance will not pay these fees. They are your responsibility and will be billed directly to you.
Can you cancel Kaiser anytime?
To cancel your benefits outside of the open enrollment period, you will need a qualifying life event, such as a spouse obtaining new group health insurance. In this case, we would require a letter from the insurance company showing the new coverage effective date.
Can I get a refund from Kaiser?
When making these payments, we may deduct any amounts you owe Kaiser Permanente or any participating providers. Refunds for overpayment of premium are provided based on the method of payment used by the member. If you believe you have overpaid your premium and are due a refund, please contact Member Services.
How long can you stay on your parents insurance Kaiser Permanente?
If you are attending school outside of our service area and are a dependent child of a Kaiser Permanente member, you may be able to keep your coverage while away at school. If you're under the age of 26, you have the option to stay on your parents' health insurance plan.
How to change Kaiser insurance plan?
By phone: Call 1-800-464-4000 (TTY 711) to make your account change over the phone.
How do I cancel my Kaiser payment plan?
For questions, modification, or cancellation regarding your payment plan Contact Kaiser Permanente at 800-390-3507 (TTY 711), 6 a.m. to 5 p.m., PT. At any time, you may pay more than your established monthly payment amount.
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What is Kaiser Permanente Student Health Plan Enrollment/Change Form?
The Kaiser Permanente Student Health Plan Enrollment/Change Form is a document used by students to enroll in or make changes to their health insurance plan provided by Kaiser Permanente.
Who is required to file Kaiser Permanente Student Health Plan Enrollment/Change Form?
Students who wish to enroll in the Kaiser Permanente Student Health Plan or make changes to their existing enrollment must file the form.
How to fill out Kaiser Permanente Student Health Plan Enrollment/Change Form?
To fill out the form, students should provide personal information, select their desired coverage options, and submit any required documentation as specified on the form.
What is the purpose of Kaiser Permanente Student Health Plan Enrollment/Change Form?
The purpose of the form is to facilitate the enrollment process for students seeking health insurance coverage through Kaiser Permanente, as well as to allow for any necessary changes in their insurance status.
What information must be reported on Kaiser Permanente Student Health Plan Enrollment/Change Form?
Students must report personal details such as name, date of birth, student ID, contact information, coverage selections, and any other required details outlined on the form.
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