Get Dental Enrollment Form For Dependents - Indiana University - Indiana

Filling out the Dental Enrollment Form for Dependents at Indiana University is a straightforward process that requires attention to detail. This guide provides you with step-by-step instructions to ensure your application is completed accurately and submitted on time.

Follow the steps to complete your Dental Enrollment Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. You can access the form to get started with your enrollment.
2. Begin by selecting your plan option. Indicate your policy number and select the Dental PPO option.
3. Complete all student information thoroughly, including your last name, first name, middle initial, student ID number, email address, mailing address, city, state, zip code, and phone number. Incomplete information could delay processing.
4. Provide your date of birth, sex, and list all dependents to be insured, including their last names, first names, dates of birth, social security numbers, and genders.
5. Select the enrollment period for your dependents, ensuring they are enrolled in the same plan as you. Provide the payment method for the premiums, including making checks payable to Aetna Student Health or specifying credit card details.
6. Sign the enrollment form, acknowledging your agreement to the terms specified. Make sure to provide a valid signature and date before submitting your application.
7. After completing the form, you can save the changes, download the form, print it, or share it as needed.

Complete your Dental Enrollment Form online today to ensure your dependents are covered!