Get Student Dependent Filable Form

This guide provides a comprehensive overview of filling out the Student Dependent Filable Form online. Users will find step-by-step instructions tailored to their specific needs.

Follow the steps to complete the Student Dependent Filable Form efficiently.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by entering the student's name and ID number. Ensure that information is accurate and matches your official documents.
3. Fill in the permanent U.S. mailing address, including the street, city, state, and zip code. Double-check for typos to avoid mail delivery issues.
4. Input the date of birth using the format provided (month, day, year) to ensure that it is compliant with the form's requirements.
5. Provide the contact phone number and email address. This information may be used for important updates or communications regarding the enrollment.
6. List the dependents to be insured by entering their names, birth dates, and gender in the designated fields. Ensure all listed dependents are eligible.
7. Attach required documentation for each dependent, such as a marriage certificate for spouses or a birth certificate for children, ensuring that all documents are properly labeled.
8. Review the premium costs applicable to the selected coverage plan. Check the boxes for the desired coverage type (e.g., spouse, children, family).
9. Choose the payment method by marking the appropriate box and filling in necessary details for checks or credit cards.
10. Sign and date the form at the designated section. A signature is required to validate the information provided in the form.
11. Once all parts of the form are completed, save the changes, and if necessary, download, print, or share the form as needed.

Complete your Student Dependent Filable Form online to ensure your dependents receive the necessary health coverage.