Get University Of Texas At Arlington Blue Cross And Blue ...

Completing the UNIVERSITY OF TEXAS AT ARLINGTON Blue Cross and Blue Shield enrollment form is essential for students seeking health insurance coverage. This guide provides detailed, step-by-step instructions to help users fill out the form accurately and efficiently online.

Follow the steps to complete your health insurance enrollment form.

1. Press the ‘Get Form’ button to access the enrollment form. This will open the document in your chosen editor for completion.
2. Begin by entering the student's name in the designated fields: First, Middle Initial, and Last. Ensure that the name matches official identification to avoid any discrepancies.
3. Provide the mailing address for confirmation emails. Enter the Street or P.O. Box, City, State, and Zip Code in the appropriate sections.
4. Fill in the permanent address if it differs from the mailing address. Repeat the same details as in step 3.
5. Input the cell or telephone number and email address. These will be used for communication regarding the health coverage.
6. Mark the appropriate box to indicate the gender of the student, and input the date of birth in the specified format (Month/Day/Year).
7. Enter the Student ID number in the field provided to verify enrollment status.
8. List any dependents to be covered under this insurance by providing their personal information: First Name, Middle Initial, Last Name, Date of Birth, Gender, and Social Security Number.
9. Review the notice regarding coverage effectiveness and payment responsibilities, ensuring understanding of the terms related to coverage and payments.
10. Sign and date the form where indicated, noting that a parent or guardian must sign if the student is under 18.
11. Select the desired coverage plan and payment option, then enter payment details if paying by credit card. Ensure all amounts are filled accurately.
12. Confirm all information for accuracy before saving the form. You have the option to download, print, or share the completed form as needed.

Complete your enrollment form online today to secure your health insurance coverage!