Get Change, Cancel, Or Enroll Form - Office Of Student Health Benefits ... - Shb Umn

This guide provides clear and supportive instructions on how to complete the Change, Cancel, or Enroll Form for the Office of Student Health Benefits. By following these steps, users can efficiently manage their enrollment in the Voluntary Student Dental Plan.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the Change, Cancel, or Enroll Form and open it for editing.
2. Fill in your member information in Section A. This includes your name (last, first, middle initial), date of birth, gender, University of Minnesota ID number, social security number, and your address including city, state, and ZIP code.
3. Enter your daytime phone number and email address. Select your campus from the options provided: Crookston, Duluth, Morris, Rochester, or Twin Cities.
4. Indicate what action you wish to take by checking one of the options: request enrollment in the Voluntary Student Dental Plan, cancel your enrollment request, or make a change. Note that name and address changes must be processed through your campus registration website prior to updating in OSHB records.
5. In Section B, acknowledge the year-long coverage by confirming your understanding of the terms regarding enrollment and authorization for charges to your student account. Make sure to sign and date the form in the designated area.
6. Once all information is completed and verified, save any changes made to the form. You can then download, print, or share the form as needed.

Complete your Change, Cancel, or Enroll Form online today for efficient management of your student health benefits.