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UNITED HEALTHCARE RHODE ISLAND SCHOOL OF DESIGN 2014 2015 STUDENT INSURANCE ENROLLMENT CARD FOR DEPENDENTS (PLEASE PRINT) Students Name Last First MI Permanent U.S. Address Street or PO Box City State
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How to fill out United Healthcare Rhode Island:

01
Gather necessary information: Before starting the application process, collect all the required information such as personal identification details, contact information, income details, and any other relevant documents.
02
Access the United Healthcare Rhode Island application: Go to the United Healthcare Rhode Island website or visit the nearest United Healthcare office to obtain the application form. Alternatively, you can call their customer service helpline to request an application.
03
Provide personal information: Fill out the application form by providing accurate personal information, including your full name, date of birth, social security number, and address.
04
Include contact details: Specify your contact information, such as your phone number and email address, to ensure United Healthcare can reach you for any communication or updates regarding your application.
05
Declare household income: Provide information about your household income, including wages, self-employment income, retirement benefits, social security benefits, and any other sources of income. This information helps determine your eligibility for specific United Healthcare plans.
06
Declare current healthcare coverage: Indicate whether you currently have any other form of health insurance coverage, such as Medicare or Medicaid. This information helps determine your eligibility for United Healthcare Rhode Island.
07
List dependents: If you want to enroll dependents, such as children or spouse, include their names, dates of birth, and social security numbers on the application form.
08
Review and submit the application: Double-check all the entered information for accuracy and completeness. Make sure all the required fields are filled out properly. Sign and date the application form and submit it through the provided method, which can include online submission, mailing, or personally delivering it to a United Healthcare office.

Who needs United Healthcare Rhode Island:

01
Rhode Island residents: United Healthcare Rhode Island is specifically designed for residents of Rhode Island who require health insurance coverage.
02
Individuals without employer-sponsored insurance: If you do not have access to health insurance through your employer or any other source, United Healthcare Rhode Island can provide you with coverage options.
03
Low-income individuals and families: United Healthcare Rhode Island may be suitable for individuals and families with low income who meet the eligibility criteria for Medicaid or subsidized health insurance plans.
04
Seniors and individuals with disabilities: United Healthcare Rhode Island offers various Medicare Advantage plans that cater to the unique healthcare needs of seniors and individuals with disabilities.
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United Healthcare Rhode Island refers to the healthcare insurance services provided by the United Healthcare company in the state of Rhode Island.
Employers or individuals who have purchased United Healthcare insurance in Rhode Island are required to file United Healthcare Rhode Island forms.
United Healthcare Rhode Island forms can be filled out online or by mail, following the instructions provided by United Healthcare.
The purpose of United Healthcare Rhode Island is to report healthcare insurance information for individuals or employers in the state.
Information such as policy details, coverage dates, and insured individuals must be reported on United Healthcare Rhode Island forms.
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2015 2014 Rhode_Island Batterymarch refundable elects DEPENDENTS refunded Eligibility acknowledges ENROLLMENT HEALTHCARE enroll payable renewal timely rated premium requirements Spouse Brochure

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