Get the free Continuation Enrollment Form for Students and Their Dependents

This document is an enrollment form for students and their dependents to continue their insurance coverage through UnitedHealthcare Insurance Company of New York after their regular student plan expires.

How to fill out continuation enrollment form for

How to fill out Continuation Enrollment Form for Students and Their Dependents

1. Obtain the Continuation Enrollment Form from the institution's website or student services office.
2. Fill out the student's personal information including name, student ID, and contact details.
3. Provide details regarding the enrollments for each dependent, including their names and relationships to the student.
4. Indicate the type of coverage required for each dependent by selecting the appropriate options on the form.
5. Double-check all entered information for accuracy and completeness.
6. Sign and date the form to certify that all information provided is correct.
7. Submit the completed form to the designated department by the specified deadline.

Who needs Continuation Enrollment Form for Students and Their Dependents?

1. Students who wish to keep their health insurance coverage while enrolled in school.
2. Dependents of students who need to be added to the student’s health insurance plan.
3. Students who are transferring or continuing their education and require continued health insurance enrollment.

People Also Ask about

What is a student enrollment form?

A college enrollment form is a document that students and parents fill out immediately following admission to a college, university, or technical school.

What is the meaning of enrollment form?

An enrolment form is a document that individuals fill out to register for a program, service, or event. This form collects essential information, such as personal details and contact information, ensuring the organization can manage participants effectively.

What are school enrollment forms?

An enrollment form is a document that allows parents to sign up their child for a school program, class, or camp. Whether you're serving families at a public school, private school, or homeschooling organization, use a School Enrollment Form to stay organized and keep track of your students!

What can I use as proof of school enrollment?

Examples of valid documents: Enrolment letter. Invoice or payment receipt for tuition. Timetable or course schedule.

What is a school enrollment form?

An enrollment form is a document that allows parents to sign up their child for a school program, class, or camp.

What does student enrollment mean?

Student enrollment refers to the act of signing up for school and/or specific classes or co-curricular activities at that particular school. The enrollment process is completed after a student is granted admission to a particular school.

For pdfFiller’s FAQs

What is Continuation Enrollment Form for Students and Their Dependents?

The Continuation Enrollment Form for Students and Their Dependents is a document used by students to maintain their enrollment status and ensure continued eligibility for educational benefits, particularly concerning health insurance coverage for themselves and their dependents.

Who is required to file Continuation Enrollment Form for Students and Their Dependents?

Students who are enrolled in an educational institution and wish to maintain their health insurance coverage, as well as their dependents, are typically required to file the Continuation Enrollment Form.

How to fill out Continuation Enrollment Form for Students and Their Dependents?

To fill out the Continuation Enrollment Form, students should provide personal details such as name, student ID, and contact information, as well as specifics regarding their dependents, including names, dates of birth, and relationship to the student. The form should be completed following the instructions provided by the educational institution or insurance provider.

What is the purpose of Continuation Enrollment Form for Students and Their Dependents?

The purpose of the Continuation Enrollment Form is to allow students and their dependents to maintain their health insurance coverage beyond the standard enrollment period, ensuring they have access to necessary medical services while continuing their education.

What information must be reported on Continuation Enrollment Form for Students and Their Dependents?

The information that must be reported includes the student's name, student ID, and contact information, as well as details about the dependents such as their names, dates of birth, and the nature of their relationship to the student. Additionally, any relevant personal or educational circumstances may need to be disclosed.