Get the free Graduate Assistant Health Plan Continuation of Coverage Enrollment Form - shb umn
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This form is intended for members of the Graduate Assistant Health Plan who have lost eligibility and wish to continue their coverage for an additional 18 months at their own expense. Members must
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How to fill out graduate assistant health plan
How to fill out Graduate Assistant Health Plan Continuation of Coverage Enrollment Form
01
Obtain the Graduate Assistant Health Plan Continuation of Coverage Enrollment Form from the university's website or administration office.
02
Read the instructions carefully to understand the requirements for filling out the form.
03
Fill in your personal information, including your name, student ID, and contact details, in the designated fields.
04
Indicate your current status as a Graduate Assistant and provide the start and end dates of your assistantship.
05
Specify the coverage you wish to continue and any dependents you want to include in the plan.
06
Review the payment options and indicate your preferred method for premium payments.
07
Sign and date the form to confirm that all information provided is accurate.
08
Submit the completed form to the required office before the enrollment deadline.
Who needs Graduate Assistant Health Plan Continuation of Coverage Enrollment Form?
01
Graduate assistants who wish to continue their health coverage after their assistantship ends.
02
Those who are no longer eligible for the university's health insurance and require ongoing health coverage.
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What is Graduate Assistant Health Plan Continuation of Coverage Enrollment Form?
The Graduate Assistant Health Plan Continuation of Coverage Enrollment Form is a document that allows graduate assistants to continue their health insurance coverage after their eligibility ends.
Who is required to file Graduate Assistant Health Plan Continuation of Coverage Enrollment Form?
Graduate assistants who wish to maintain their health insurance coverage after their appointment ends are required to file this form.
How to fill out Graduate Assistant Health Plan Continuation of Coverage Enrollment Form?
To fill out the form, provide personal information such as your name, student ID, and the dates of your graduate assistant appointment, along with selecting your desired coverage options.
What is the purpose of Graduate Assistant Health Plan Continuation of Coverage Enrollment Form?
The purpose of the form is to facilitate the continuation of health insurance coverage for eligible graduate assistants who may otherwise lose their health benefits upon the conclusion of their assistantship.
What information must be reported on Graduate Assistant Health Plan Continuation of Coverage Enrollment Form?
The form requires reporting personal information, appointment details, health coverage preferences, and any dependent information, if applicable.
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