Get Gahp Duluth Enrollment Form - Shb Umn

Completing the GAHP Duluth Enrollment Form – Shb Umn online is a straightforward process designed to help users enroll in the Graduate Assistant Health Plan efficiently. This guide will walk you through each section of the form, providing clear instructions to assist you in submitting your enrollment accurately.

Follow the steps to complete your enrollment form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your Graduate Assistant information—including your name, date of birth, gender, U of M ID number, street address, city, state, ZIP code, daytime phone number, and UMN email address. Ensure all information is accurate and clearly printed.
3. Indicate your preference to enroll in the Graduate Assistant Health Plan by selecting ‘Yes’ and understand that the cost will vary based on your appointment type.
4. In the dependent enrollment section, choose the plan for your dependents and list the names of those to be covered. All dependents must be enrolled in the same plan.
5. Fill in the required details for each dependent, such as their names, dates of birth, gender, and Social Security numbers, ensuring to provide complete and accurate information.
6. Sign and date the authorization section to allow the release of medical information, ensuring that the information provided is complete and accurate.
7. Review the payment section to calculate your total amount due, then select your payment method. You will need to indicate whether you are enclosing a check, opting for credit card charges, or requiring monthly payment coupons.
8. If applicable, enter your credit card information securely and sign to authorize the charges.
9. After completing the form, save any changes. You may then download, print, or share the form as needed.

Complete your GAHP Duluth Enrollment Form online to secure your health plan coverage.