Get the free UVA Health Plan and Dental Plan Enrollment Application - hr virginia

This document serves as an application for enrollment in the University of Virginia's health and dental plans, detailing employment status, coverage options, applicant information, and waive coverage

How to fill out uva health plan and

How to fill out UVA Health Plan and Dental Plan Enrollment Application

1. Obtain the UVA Health Plan and Dental Plan Enrollment Application form from the UVA website or Human Resources.
2. Read the instructions carefully to understand the eligibility requirements and the enrollment process.
3. Fill out your personal information, including your name, address, and contact details in the designated fields.
4. Indicate your selection for the health plan and dental plan by checking the appropriate boxes.
5. Provide information about any dependents you wish to enroll, including their names, dates of birth, and relationship to you.
6. Review the form for accuracy and completeness to ensure all required fields are filled out.
7. Sign and date the application at the designated area to validate your enrollment request.
8. Submit the completed application form to the appropriate UVA department, either electronically or by mail, as per the guidelines.

Who needs UVA Health Plan and Dental Plan Enrollment Application?

1. All employees of UVA who are eligible for health and dental benefits.
2. New hires during the onboarding process to ensure they have access to health and dental plans.
3. Current employees who wish to enroll, make changes, or terminate their coverage during the open enrollment period.

For pdfFiller’s FAQs

What is UVA Health Plan and Dental Plan Enrollment Application?

The UVA Health Plan and Dental Plan Enrollment Application is a formal document used by individuals to apply for health and dental insurance coverage provided by the University of Virginia.

Who is required to file UVA Health Plan and Dental Plan Enrollment Application?

Employees and eligible dependents who wish to enroll in the UVA Health Plan and Dental Plan are required to file this application.

How to fill out UVA Health Plan and Dental Plan Enrollment Application?

To fill out the application, individuals should provide accurate personal information, select the desired plan options, and submit any required documentation as outlined in the application instructions.

What is the purpose of UVA Health Plan and Dental Plan Enrollment Application?

The purpose of the application is to gather necessary information to determine eligibility and provide coverage for individuals seeking health and dental insurance provided by UVA.

What information must be reported on UVA Health Plan and Dental Plan Enrollment Application?

Applicants must report personal details such as name, address, date of birth, social security number, and any dependant information, along with selecting the desired health and dental coverage options.