Get the free MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14...

This form is used for enrolling in the MCPHS University Student Health Plan after waiving it and experiencing a qualifying event due to termination of other insurance.

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How to fill out MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14 Qualifying Event Enrollment Form

1. Obtain the MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14 Qualifying Event Enrollment Form.
2. Read the instructions at the top of the form before starting.
3. Fill out your personal information, including your name, address, and date of birth in the designated fields.
4. Indicate the qualifying event that applies to you, such as marriage, birth, or loss of other coverage.
5. Provide details about the qualifying event, including the date it occurred.
6. Fill in the dependent information if you are enrolling any dependents, including their names, dates of birth, and relationship to you.
7. Review your completed form for accuracy and completeness.
8. Sign and date the form at the bottom.
9. Submit the completed form to the designated office or upload it online as instructed.

Who needs MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14 Qualifying Event Enrollment Form?

1. Current students at MCPHS University who experience a qualifying event affecting their health insurance.
2. Individuals who are newly eligible for coverage due to changes in life circumstances.
3. Students needing to enroll dependents due to marriage, childbirth, or other significant events.

For pdfFiller’s FAQs

What is MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14 Qualifying Event Enrollment Form?

The MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14 Qualifying Event Enrollment Form is a document used by students or eligible members to enroll in a health insurance plan due to a qualifying life event, such as marriage, birth of a child, or loss of other coverage.

Who is required to file MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14 Qualifying Event Enrollment Form?

Students or eligible individuals who experience a qualifying life event that affects their health insurance status are required to file the form.

How to fill out MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14 Qualifying Event Enrollment Form?

To fill out the form, individuals must provide personal information including their name, contact details, and the details of the qualifying event, along with any necessary supporting documentation and signatures as indicated on the form.

What is the purpose of MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14 Qualifying Event Enrollment Form?

The purpose of the form is to allow individuals to request enrollment in the health insurance plan after experiencing a qualifying life event, ensuring they have access to health coverage when their circumstances change.

What information must be reported on MCPHS University Blue Cross Blue Shield – Blue Care Elect Preferred PPO Plan 2013-14 Qualifying Event Enrollment Form?

The form must include personal identification information, a description of the qualifying event, dates related to the event, and any relevant documentation that supports the enrollment request.