Get Please Keep A Copy Of This Form For Your Records - Shb Umn

Filling out the Please Keep A Copy Of This Form For Your Records - Shb Umn can be crucial for enrolling dependents in the Student Health Benefit Plan. This guide will provide you with a comprehensive, step-by-step process to ensure you accurately complete the form online, keeping your information organized and accessible.

Follow the steps to successfully complete the form online.

1. Begin by clicking the ‘Get Form’ button, which allows you to access the document online. This is necessary to obtain the form and activate the editing function.
2. In Section A, enter the primary member information accurately. Provide your full name as it appears in official documents, your date of birth using the specified format (mm/dd/yyyy), and your University of Minnesota ID number. Make sure to include your street address, city, state, ZIP code, daytime phone number, and University email address.
3. Indicate your desired action regarding health coverage by selecting one of the options provided. This may include enrolling dependents due to events such as birth or adoption, marriage, or termination of other coverage. You may also select to cancel coverage or make changes to your information.
4. In Section B, mark your plan preference for health coverage. Detail the dependents you wish to enroll by filling in their names, dates of birth, gender, and social security numbers, ensuring all information is clear and legible.
5. Proceed to Section C to provide your authorization for medical information release. Here, you must sign and date the form. Remember that electronic signatures are not acceptable for this form.
6. In Section E, select your payment method by circling the appropriate option and providing all necessary payment details, including account numbers and expiration dates if using a credit card.
7. Review all entered information for accuracy before proceeding. Errors could delay processing or invalidate your coverage.
8. Finally, save your changes and consider downloading the document for your records. You can print a copy or share it via email, if necessary.

Complete your form online today to ensure timely processing and peace of mind regarding your health coverage.