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This form is used by domestic graduate students at the University of Kentucky to decline student health insurance coverage.
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How to fill out Graduate Assistant/Fellowship Recipient Student Health Insurance Declination Form

01
Obtain the Graduate Assistant/Fellowship Recipient Student Health Insurance Declination Form from your university's website or student services.
02
Read the instructions carefully to ensure you understand the requirements.
03
Fill out your personal information at the top of the form, including your name, student ID, and contact information.
04
Indicate your reason for declining the health insurance coverage by checking the appropriate box provided.
05
Provide details of any alternative health insurance coverage you possess, including the insurance provider and policy number.
06
Review the form for accuracy and completeness before signing.
07
Submit the completed form to the designated office as instructed, whether it be online or in person.

Who needs Graduate Assistant/Fellowship Recipient Student Health Insurance Declination Form?

01
Graduate students who are receiving assistantships or fellowships and want to decline the offered student health insurance.
02
Students who have alternative health insurance coverage and prefer not to enroll in the university's health plan.
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The premium cost for the student health insurance plan for the 2023-2024 academic year is $2,474. Students who wish to enroll in the optional Dental and/or Vision plan will be billed an additional cost.
The premium cost for the student health insurance plan for the 2023-2024 academic year is $2,474. Students who wish to enroll in the optional Dental and/or Vision plan will be billed an additional cost.

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The Graduate Assistant/Fellowship Recipient Student Health Insurance Declination Form is a document that allows graduate assistants and fellowship recipients to formally decline the student health insurance coverage offered by their institution.
Graduate assistants and fellowship recipients who wish to decline their student health insurance coverage are required to file this form.
To fill out the form, individuals need to provide their personal information, indicate their decision to decline insurance coverage, and may need to provide details of their alternative health insurance plan.
The purpose of the form is to document the decision of graduate assistants and fellowship recipients to opt-out of the health insurance coverage provided by the university, ensuring they have their own coverage.
The form typically requires personal information such as name, student ID, contact information, a statement of declination, and details about the alternative health insurance coverage.
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