Fillable State of Iowa Certification of Dependent Status - benefits iowa

Description
Certification of Non-Student Dependent Status Employee Name: Address: ___ City: ___ State: ___ Zip:___ You may enroll your unmarried child, age 19 to 25, who lives in Iowa but is not a full-time student, on your insurance plan. Enrollment is subject to all of the State of Iowa Group Insurance Plan rules and regulations. Once you enroll your child, you will not be able to cancel their coverage until the
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