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20172018ENROLLMENT FORM Santa Ana CollegeInternational Student Insurance Incomplete the information below. Please print clearly and answer all questions, then mail to the address below. Incomplete

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How to fill out select form coverage period

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Choose the start date of your coverage period from the provided options.

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The select form coverage period is a form that indicates the period for which coverage is selected.

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Employers offering health coverage to employees are required to file select form coverage period.

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The purpose of select form coverage period is to report the coverage period for health insurance offered to employees.

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Information such as the coverage period, employee details, and coverage options must be reported on select form coverage period.

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