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NEW RENEWING8 0201718 UC LOS ANGELES MBA STUDENT SHIP ENROLLMENT FORM FOR DEPENDENTS OF REGISTERED STUDENTS Wells Fargo Student Insurance Medical ID×DEPENDENT ENROLLMENT FORMwww.ucop.edu/ucshipPlease

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How to fill out dependent enrollment form 2017-18

01

Here is how to fill out the dependent enrollment form for the year 2017-18:

02

- Begin by entering your personal information, such as your name, address, and contact details.

03

- Provide details about your dependent, including their name, date of birth, and relationship to you.

04

- Indicate whether your dependent is eligible for other insurance coverage or not.

05

- Fill in the necessary information regarding your dependent's health, including any pre-existing medical conditions.

06

- Sign and date the form to certify the accuracy of the information provided.

07

- Submit the form to the appropriate authority or healthcare provider as instructed.

Who needs dependent enrollment form 2017-18?

01

The dependent enrollment form for the year 2017-18 is needed by individuals who have dependents (such as children, spouse, or domestic partner) and wish to enroll them in a healthcare plan. It may also be required by employers or healthcare providers as part of their enrollment process.

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What is dependent enrollment form 18?

Dependent enrollment form 18 is a document used to enroll dependents in a particular program or service.

Who is required to file dependent enrollment form 18?

Dependent enrollment form 18 must be filed by individuals who have dependents that need to be enrolled in the specified program or service.

How to fill out dependent enrollment form 18?

Dependent enrollment form 18 can be filled out by providing all the required information about the dependents being enrolled.

What is the purpose of dependent enrollment form 18?

The purpose of dependent enrollment form 18 is to ensure that accurate information about dependents is provided for enrollment purposes.

What information must be reported on dependent enrollment form 18?

Information such as the dependent's full name, date of birth, relationship to the individual filing the form, and any other required details must be reported on dependent enrollment form 18.

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