Get University Of Texas At Tyler Blue Cross And Blue Shield Of ...

This guide provides detailed, step-by-step instructions for successfully completing the UNIVERSITY OF TEXAS AT TYLER Blue Cross and Blue Shield of Texas health insurance enrollment form online. It is designed to help users through each section of the form, ensuring a smooth completion process.

Follow the steps to fill out the form accurately.

1. Press the ‘Get Form’ button to retrieve the enrollment form and access it in the provided editor.
2. Complete the student's name section by entering the first, middle initial, and last name. Be sure to provide accurate spelling.
3. Fill in the mailing address, including the street or P.O. Box, city, state, and zip code. This information is important for receiving confirmation and future correspondence.
4. Next, input the permanent address if it differs from the mailing address. Ensure all components are filled out correctly.
5. Provide the student's email address, as a confirmation email will be sent to this address. Remember to verify that it is entered correctly.
6. Enter the date of birth in the format Month/Day/Year and include the cell or telephone number. This contact information is vital for reaching the student if needed.
7. State the student ID number, which may be required for processing the enrollment.
8. List any dependents that need to be insured in the provided sections. Input their first name, middle initial, last name, date of birth, gender, and social security number. Be attentive to ensure that this information is accurate as dependent coverage is tied to the student's enrollment.
9. Review the notice to students and cardholders regarding coverage effective dates and payment processes. Acknowledge understanding of the obligations and responsibilities by providing the student's and cardholder's signatures along with the corresponding dates.
10. Select the appropriate coverage plan and pricing, being mindful to check all relevant boxes to avoid issues later. Carefully read through all payment options and select one, ensuring the payment method aligns with preferences.
11. Sign where indicated, including the cardholder's signature for authorization of payment. Check the expiration date of the credit card if applicable.
12. Once all fields are completed, save changes to the form. You can choose to download or print the completed document for your records or for further distribution as necessary.

Complete your health insurance enrollment form online to ensure you have the coverage you need.