Get the free University of Virginia Health Plan National Network and Out of Area Enrollment Form ...

Este formulario es para la inscripción de empleados y sus dependientes en la cobertura de red nacional o fuera del área, en caso de que residan fuera del área del proveedor de Southern Health.

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How to fill out University of Virginia Health Plan National Network and Out of Area Enrollment Form

1. Obtain the University of Virginia Health Plan National Network and Out of Area Enrollment Form from the official website or your HR department.
2. Complete the personal information section, including your name, address, and contact details.
3. Provide your health insurance details, including any previous plans you were enrolled in.
4. Indicate whether you are enrolling in the National Network or Out of Area coverage.
5. List any dependents you wish to enroll, including their names and relationship to you.
6. Fill out any additional required sections related to your health status or medical history.
7. Review the completed form for accuracy and completeness.
8. Sign and date the form as required.
9. Submit the form to the designated office or HR department according to the instructions provided.

Who needs University of Virginia Health Plan National Network and Out of Area Enrollment Form?

1. New employees of the University of Virginia who require health insurance coverage.
2. Current employees who are making changes to their health insurance plan.
3. Dependents of employees seeking enrollment in the health plan.
4. Individuals moving out of the area who need to enroll in the Out of Area coverage.

For pdfFiller’s FAQs

What is University of Virginia Health Plan National Network and Out of Area Enrollment Form?

The University of Virginia Health Plan National Network and Out of Area Enrollment Form is a document used for enrolling individuals in the UVA Health Plan's national network, which includes coverage for services provided outside the immediate geographic area.

Who is required to file University of Virginia Health Plan National Network and Out of Area Enrollment Form?

Individuals who wish to enroll in the University of Virginia Health Plan that provides national coverage or those moving out of the service area are required to file this form.

How to fill out University of Virginia Health Plan National Network and Out of Area Enrollment Form?

To fill out the form, individuals should provide personal identification information, select the type of enrollment (national network or out of area), and include any dependent information if applicable, ensuring all sections are completed accurately.

What is the purpose of University of Virginia Health Plan National Network and Out of Area Enrollment Form?

The purpose of the form is to facilitate the enrollment process for individuals seeking health coverage under the national network, ensuring that they receive the appropriate medical benefits while traveling or residing outside their local area.

What information must be reported on University of Virginia Health Plan National Network and Out of Area Enrollment Form?

The information that must be reported includes personal details such as name, address, date of birth, insurance policy numbers, selections for coverage type, and information about any dependents being enrolled.