Get the free UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2012-13 Dependents Qua...

This form is used by students at UMASS-Worcester to enroll dependents in the Blue Cross Blue Shield Student Medical Plan due to 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 2012-13 Dependents Qualifying Event Enrollment Form

1. Obtain the UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2012-13 Dependents Qualifying Event Enrollment Form from the university website or student health services.
2. Read through the form carefully to understand the requirements and information needed for enrollment.
3. Fill out the student information section, including your full name, student ID, and contact details.
4. Complete the dependent information section for each dependent you are enrolling, including their names, dates of birth, and relationship to you.
5. Indicate the qualifying event that necessitates the enrollment of your dependents, such as marriage or birth of a child.
6. Provide the date of the qualifying event and attach any required documentation to support your claim, such as a marriage certificate or birth certificate.
7. Review the entire form for accuracy and completeness before submitting.
8. Sign and date the form to certify that all information provided is true and correct.
9. Submit the completed form to the appropriate office, either via mail or in person, as instructed on the form.

Who needs UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2012-13 Dependents Qualifying Event Enrollment Form?

1. Students who want to add eligible dependents to their health insurance coverage due to a qualifying event.
2. Individuals who have experienced life changes such as marriage, birth, or adoption that affect their health insurance needs.
3. Students enrolled in the UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan that wish to ensure coverage for their dependents.

For pdfFiller’s FAQs

What is UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2012-13 Dependents Qualifying Event Enrollment Form?

The UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2012-13 Dependents Qualifying Event Enrollment Form is a document that allows eligible students to enroll their dependents in the health insurance plan due to qualifying life events.

Who is required to file UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2012-13 Dependents Qualifying Event Enrollment Form?

Students who have experienced a qualifying event such as marriage, birth, or adoption of a child are required to file this form to enroll their dependents in the health insurance plan.

How to fill out UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2012-13 Dependents Qualifying Event Enrollment Form?

To fill out the form, students must provide their personal information, details of the qualifying event, and the information of the dependents they wish to enroll. They should follow the instructions provided on the form closely.

What is the purpose of UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2012-13 Dependents Qualifying Event Enrollment Form?

The purpose of the form is to allow eligible students to add dependents to their health insurance coverage when a qualifying life event occurs, ensuring the dependents receive medical benefits.

What information must be reported on UMASS-Worcester Blue Cross Blue Shield - Student Medical Plan 2012-13 Dependents Qualifying Event Enrollment Form?

The form must report the student's identification details, the nature of the qualifying event, and personal information of the dependents being added, including their names, birth dates, and relationship to the student.