Get the free SUNY Dependant Medical Enrollment Form

This form is used for enrolling dependents of students, scholars, or faculty members affiliated with SUNY for medical and evacuation coverage.

How to fill out suny dependant medical enrollment

How to fill out SUNY Dependant Medical Enrollment Form

1. Obtain the SUNY Dependant Medical Enrollment Form from the official SUNY website or your campus health office.
2. Fill in your personal details including your name, student ID, and contact information.
3. Provide information about your dependent(s), such as their name, date of birth, and relationship to you.
4. Indicate the type of coverage you wish to enroll your dependent(s) in (e.g., medical, dental).
5. Ensure that all required fields are completed accurately.
6. Review the form for any errors or missing information.
7. Sign and date the form at the bottom to certify that all information provided is accurate.
8. Submit the completed form to your campus health office or the designated administrative office by the deadline.

Who needs SUNY Dependant Medical Enrollment Form?

1. Students enrolled in SUNY who wish to include their dependents (such as children or spouses) in their medical insurance coverage.

For pdfFiller’s FAQs

What is SUNY Dependant Medical Enrollment Form?

The SUNY Dependant Medical Enrollment Form is a document used by the State University of New York (SUNY) system to enroll dependents in the university's health insurance plans.

Who is required to file SUNY Dependant Medical Enrollment Form?

Employees of SUNY who wish to add dependents to their health insurance coverage are required to file the SUNY Dependant Medical Enrollment Form.

How to fill out SUNY Dependant Medical Enrollment Form?

To fill out the SUNY Dependant Medical Enrollment Form, individuals must provide personal information, including the employee's details and those of the dependents being enrolled, as well as necessary documentation to verify dependent status.

What is the purpose of SUNY Dependant Medical Enrollment Form?

The purpose of the SUNY Dependant Medical Enrollment Form is to officially request the addition of dependents to an employee's existing health insurance plan within the SUNY system.

What information must be reported on SUNY Dependant Medical Enrollment Form?

Information that must be reported includes the employee's name and identification number, dependent's names, their relationship to the employee, social security numbers, and dates of birth, as well as any relevant supporting documentation.