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Duquesne University Student Health Insurance Plan 2012-2013 Policy Year Dependent Enrollment Form (Please Print) Student Name Last First Initial Home Address Street City State Zip Code Banner ID #
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Student Enrollment Plan rates are for students who are students. Students will not lose coverage if they: • enroll in a joint-career course of academic study • change coverage of dependent or non-dependent children to another plan for graduate or professional study. • leave the plan for one year or less in which to obtain health care in any way prohibited by this section. However, dependent students are permitted to participate in their own health insurance (but not dependent students of faculty or staff), except that they are not required to purchase a separate non-student health plan.2) To receive coverage on the plan, student must have graduated from high school prior to the October 7th plan year, and have attended the University for any period of time after graduation.3) For family coverage, family members of students, faculty, and staff members must enroll in the plan by December 31 and maintain the appropriate level of coverage for a full year; this includes children under age 18 who have no coverage at all on their own and dependents under age 25 who have no coverage at all. Family members of faculty and staff members must enroll in the plan by December 31, or by the September 16th plan year. The following individuals do not participate in the plan until March 1, 3:1) Students who leave the plan at the end of their first year to do graduate or professional study (May 31, 2008 – March 31, 2009) 2) Students who leave the plan due to a loss of coverage at medical school.3) Students enrolled during the fall semester who leave the plan during the Spring semester for any reason. The Student Information Gateway will be the only authorized source for verification of enrollment information. Please confirm your enrollment at Student.health.edu, not Student.health.gov. Student Health Insurance Plan 3 Policy Year Dependent Enrollment Form (Please Print) Student Name Last First Initial Home Address Street City State Zip Code Banner ID # Male Female Date of Birth / / M D Y Phone Number Email Address DEPENDENT ENROLLMENT Please circle selected coverage. Annual (07/31/2013 04/07/2014) Enrollment Deadline Plan Rates July 31, 20111,976.56 Spouse or Child 2,924.16 Family Rates listed above are the.1. Student Enrollment Plan rates are for students who are students.

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Amherst college dependent medical refers to the medical coverage provided by Amherst College for the dependents of its employees.
Amherst College employees with dependents are required to file amherst college dependent medical.
To fill out amherst college dependent medical, employees need to provide the necessary information about their dependents, such as their names, dates of birth, and any relevant medical details.
The purpose of amherst college dependent medical is to provide medical coverage and support for the dependents of Amherst College employees.
The amherst college dependent medical form typically requires information about the dependent's name, date of birth, and any relevant medical details that may impact eligibility or coverage.
The deadline to file amherst college dependent medical in 2023 will be determined and communicated by Amherst College.
The penalty for the late filing of amherst college dependent medical may vary depending on the specific policies and guidelines set by Amherst College. It is recommended to refer to the official documentation or contact the HR department for accurate information.
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