Get Application For Senior Dependent Rider - Wayne State University - Wayne
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How to fill out the Application For Senior Dependent Rider - Wayne State University - Wayne online
Completing the Application For Senior Dependent Rider is essential for those wishing to enroll their eligible senior dependents in a medical plan. This guide provides a clear, step-by-step approach to filling out the application efficiently and accurately.
Follow the steps to complete your application successfully.
- Click 'Get Form' button to obtain the form and access it in the editor.
- Fill out the subscriber information section. Enter the name of the employee (last, first, middle), daytime phone number, social security number, e-mail address, and Banner ID.
- Proceed to the senior dependent information section. Provide the senior dependent's name (last, first, middle), sex, social security number, and address (street, city, county, state, zip). Include the date of birth of the dependent.
- Next, complete the Medicare information. Input the Medicare number, relationship to the dependent, and check the box to confirm that a copy of the Medicare card is attached. Also, provide the effective dates for Hospital Insurance (Part A and Part B).
- In the certification section, review the statements regarding the senior dependent's eligibility criteria. Ensure all statements are accurate and applicable before signing.
- Finally, sign and date the application. This certifies that the information provided is true and correct. Ensure all required documentation, such as a copy of the tax form and Medicare card, is attached before submission.
- After reviewing all entries for accuracy, you can save changes, download, print, or share the completed form as needed.
Complete your Application For Senior Dependent Rider online today and ensure your dependent's enrollment in the medical plan.
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A student is considered a senior when they have completed 90 credits or more at Wayne State University. This classification allows students to participate in senior-level courses and take advantage of various academic opportunities. For those interested in the Application For Senior Dependent Rider - Wayne State University - Wayne, ensuring you meet the credit requirement is vital for accessing the benefits designed for seniors.
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