Get Gahp Duluth Changecancellation Form - Shb Umn

This guide will help you navigate the process of completing the GAHP Duluth ChangeCancellation Form - Shb Umn online. The form is essential for managing changes to your Graduate Assistant Health Plan, ensuring your information is up-to-date and accurately reflects your coverage needs.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the GAHP Duluth ChangeCancellation Form - Shb Umn. This action will allow you to open the form for editing.
2. Begin by filling in your graduate assistant information. This includes your name, date of birth, gender, university ID number, street address, city, state, ZIP code, daytime phone number, and UMN email address. Make sure to print your name clearly.
3. Indicate if your contact information has changed by checking the appropriate box and providing your new details in the designated fields. If your name has changed, include both your new name and your previous name.
4. In the dependent additions section, select the plan you wish to enroll your dependents in and list their names. Ensure all dependents fit under the same plan. Provide their date of birth, gender, social security number, and reason for their addition.
5. If applicable, fill out the cancellations section by clearly listing the dependents whose coverage you wish to cancel. You can indicate if you want to maintain your own coverage while canceling dependent coverage.
6. Sign the form where indicated to authenticate your request. Remember, electronic signatures will not be accepted.
7. Enter the payment method details in the payment section if you are enrolling dependents. You can choose to pay by check, money order, or credit card, as specified in the provided options.
8. Complete the credit card information if applicable. Provide all necessary details, including credit card type, number, expiration date, and the authorizing signature. Ensure your signature is added to confirm the payment authorization.
9. Review all filled sections carefully for accuracy before finalizing the form. Once confirmed, save, download, or print the completed form to keep for your records.

Start completing your GAHP Duluth ChangeCancellation Form - Shb Umn online today to ensure your health plan coverage is accurate and up-to-date.