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This document is a form for students at UMASS-Worcester to enroll their dependents in the Student Health Insurance Plan. It includes information on coverage rates, enrollment deadlines, payment instructions,
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How to fill out UMASS-WORCESTER 2010-2011 STUDENT HEALTH INSURANCE PLAN DEPENDENT ENROLLMENT FORM

01
Obtain the UMASS-WORCESTER 2010-2011 STUDENT HEALTH INSURANCE PLAN DEPENDENT ENROLLMENT FORM from the university's website or student services office.
02
Carefully read the instructions provided on the form to understand the requirements for dependent enrollment.
03
Complete the section with the dependent's personal information, including their full name, date of birth, and relationship to the student.
04
Fill out the student's information section accurately, ensuring all details match university records.
05
Provide any required supporting documentation, such as proof of dependency (e.g., birth certificate or legal documents).
06
Review your completed form for accuracy and completeness.
07
Submit the form by the specified deadline, either online, by mail, or in person to the appropriate office.

Who needs UMASS-WORCESTER 2010-2011 STUDENT HEALTH INSURANCE PLAN DEPENDENT ENROLLMENT FORM?

01
Students who wish to enroll their dependents (such as children or spouses) in the UMASS-WORCESTER student health insurance plan.
02
Families or guardians of students at UMASS-WORCESTER who require health coverage for their dependents.
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People Also Ask about

How to Waive the Student Health Plan Log into WISER. On the home screen, go to "Student Financial Center." Under "Health Insurance," click on "Waive/Enroll in Health Insurance." This opens the University Health Plans (UHP) site in a new tab. In the UHP site menu, under "Student Health Plan," click "Waiver Form."
Waiver Process and Requirements Once logged in select "Student Center/Finance", click on "Health Insurance Form", then complete and submit. Students should only complete a waiver form if they are covered by a comprehensive health insurance plan that provides emergency and non-emergency care in the UMass Lowell area.
Cancel Coverage To request cancellation of coverage during open enrollment, complete and submit a cancellation request form during open enrollment. Because health insurance is a University requirement, if you cancel your medical plan coverage, you must also submit a health insurance waiver request form.
How to Waive Your SHBP Through SPIRE. Once in SPIRE, navigate to the Finances tile. On the left menu bar, select Health Insurance Waiver. Through UHS website. Navigate to UHS Waive SHBP page. Read the instructions and FAQs for more information on waiving the SHBP.
How to Waive Your SHBP Through SPIRE. Once in SPIRE, navigate to the Finances tile. On the left menu bar, select Health Insurance Waiver. Through UHS website. Navigate to UHS Waive SHBP page. Read the instructions and FAQs for more information on waiving the SHBP.

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The UMASS-WORCESTER 2010-2011 STUDENT HEALTH INSURANCE PLAN DEPENDENT ENROLLMENT FORM is a document used by students to enroll their dependents in the health insurance plan offered by the University of Massachusetts Worcester for the academic year of 2010-2011.
Students at UMASS Worcester who wish to add their dependents to the university's health insurance plan are required to file this form.
To fill out the form, students need to provide their personal information, details about their dependents, and any necessary documentation supporting the enrollment process. It may involve completing specific sections and signing the form before submission.
The purpose of the form is to officially enroll eligible dependents in the student health insurance plan, ensuring they have access to medical services and coverage offered by the university.
The form must include the student's personal details, dependent's information (such as names, dates of birth, and relationship to the student), and any required signature or certification declarations.
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