Get the free UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qua...

This form is used for enrolling dependents in the UMass Worcester Blue Cross Blue Shield Student Medical Plan during qualifying events such as marriage, birth, or adoption.

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How to fill out UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qualifying Event Enrollment Form

1. Obtain the UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qualifying Event Enrollment Form from the university's website or medical office.
2. Read the instructions carefully to understand the required information and any documentation needed.
3. Fill in your personal details, including your name, student ID, and contact information.
4. Provide information about the dependent(s) you wish to enroll, including their name, date of birth, and relationship to you.
5. Clearly indicate the qualifying event that necessitates the enrollment, such as marriage, birth of a child, or loss of other coverage.
6. Attach any required documentation that supports the qualifying event, such as a marriage certificate or birth certificate.
7. Review the completed form for accuracy and completeness.
8. Sign and date the form to confirm that all information is true and accurate.
9. Submit the form to the appropriate office at UMASS-Worcester by the specified deadline (via mail or in-person).

Who needs UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qualifying Event Enrollment Form?

1. Students enrolled in the UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan who are adding dependents due to a qualifying event.
2. Students who have experienced life changes such as marriage, birth of a child, or loss of other health insurance coverage that requires them to enroll dependents.

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What is UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qualifying Event Enrollment Form?

The UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qualifying Event Enrollment Form is a document used to enroll eligible dependents in the student medical plan due to qualifying life events such as marriage, birth, or loss of other coverage.

Who is required to file UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qualifying Event Enrollment Form?

Students who are enrolled in the UMASS-Worcester Blue Cross Blue Shield Student Medical Plan and wish to add dependents as a result of a qualifying event are required to file this form.

How to fill out UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qualifying Event Enrollment Form?

To fill out the form, complete all required fields with accurate information about the student and the dependents being enrolled. Be sure to provide necessary documentation that verifies the qualifying event, sign the form, and submit it to the appropriate office.

What is the purpose of UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qualifying Event Enrollment Form?

The purpose of the form is to facilitate the addition of dependents to the student medical plan after a qualifying event, ensuring that they receive the necessary health coverage.

What information must be reported on UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2013-14 Dependents Qualifying Event Enrollment Form?

The form must report information such as the student's personal details, the dependents’ names and relationship to the student, the nature of the qualifying event, and any required supporting documents.