AK Aetna AlaskaCare Verification of Student Status Form 2014 free printable template
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Student Status Verification Form
Member Information
Member Name
Member ID
Member Phone Number
Dependent Information
Child Name
Relationship
Child DOB
The dependent identified above is enrolled as
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How to fill out AK Aetna AlaskaCare Verification of Student Status
How to fill out AK Aetna AlaskaCare Verification of Student Status Form
01
Obtain the AK Aetna AlaskaCare Verification of Student Status Form from the official Aetna or AlaskaCare website.
02
Fill in the student's personal information, including their full name, date of birth, and student ID number.
03
Specify the educational institution the student is attending, including the name, address, and contact information.
04
Indicate the student's enrollment status, whether they are full-time or part-time.
05
Provide the academic year for which the verification is being submitted.
06
Sign and date the form to certify that the information provided is accurate.
07
Submit the completed form to the designated contact at Aetna or AlaskaCare as outlined in the submission instructions.
Who needs AK Aetna AlaskaCare Verification of Student Status Form?
01
Students who are enrolled in post-secondary education and are beneficiaries of the AK Aetna AlaskaCare plan.
02
Parents or guardians of dependent students who need to verify their student status for health coverage purposes.
03
Individuals who are required to confirm their student status for health insurance eligibility.
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What is AK Aetna AlaskaCare Verification of Student Status Form?
The AK Aetna AlaskaCare Verification of Student Status Form is a document used to verify the enrollment status of dependents in student health plans offered by Aetna for AlaskaCare members.
Who is required to file AK Aetna AlaskaCare Verification of Student Status Form?
Dependents of AlaskaCare members who are college students and wish to maintain their health coverage under the Aetna plan are required to file this form.
How to fill out AK Aetna AlaskaCare Verification of Student Status Form?
To fill out the form, the member or dependent must provide personal information, including the enrolled student's name, school details, and proof of enrollment status for the current or upcoming semester.
What is the purpose of AK Aetna AlaskaCare Verification of Student Status Form?
The purpose of the form is to confirm that enrolled dependents are actively pursuing their education, which is necessary to maintain eligibility for health coverage under the Aetna student plan.
What information must be reported on AK Aetna AlaskaCare Verification of Student Status Form?
The information that must be reported includes the student's full name, the name of the educational institution, student identification number, enrollment status, and the dates in which the student is enrolled.
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