We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use.
Click "here" to read our Cookie Policy. By clicking "Accept" you agree to the use of cookies. Read less
Read more
Accept
Loading
Form preview
  • US Legal Forms
  • Form Library
  • More Forms
  • More Multi-State Forms
  • Student Continuation Coverage Payment Receipt - Slu

Get Student Continuation Coverage Payment Receipt - Slu

Rage Start Date: Continuation Coverage End Date: Total Amount Due: Rates: SINGLE $1,842 / 6 mths; Method of Payment: DOUBLE $3,588 / 6 mths; FAMILY $5,058 / 6 mths Check (Make checks payable to: University Health Plan) Credit Card - Visa Credit Card - Master Card Credit Card - American Express Credit Card - Discover Credit Card Number: Expiration Date: Name on Card: Credit Card Billing Address: Credit Card Billing City, State: Credit Card Billing Zip: I agree to pay amount noted above acc.

How it works

  1. Open form

    Open form follow the instructions

  2. Easily sign form

    Easily sign the form with your finger

  3. Share form

    Send filled & signed form or save

How to fill out the Student Continuation Coverage Payment Receipt - Slu online

This guide provides a detailed, step-by-step approach to completing the Student Continuation Coverage Payment Receipt - Slu online. Whether you are familiar with digital forms or new to this process, these instructions will help ensure a smooth submission.

Follow the steps to complete your payment receipt accurately.

  1. Click the ‘Get Form’ button to access the payment receipt form and open it for editing.
  2. Enter your Banner ID number in the designated field to identify your account.
  3. Fill in your name as it appears on your student records.
  4. Provide the date your regular coverage ends in the corresponding field.
  5. Indicate the start date for your continuation coverage.
  6. Enter the end date for your continuation coverage.
  7. Specify the total amount due based on your selected coverage type.
  8. Choose your method of payment from the provided options: Check or Credit Card.
  9. If paying by credit card, enter your credit card number, expiration date, and the name as shown on the card.
  10. Fill in the credit card billing address, including the city, state, and zip code.
  11. Review the agreement to pay the amount noted, then provide your signature and date.
  12. After completing the form, save your changes, download, print, or share the payment receipt as needed.

Complete your documents online with confidence and ensure your coverage continues smoothly.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Get form

Related content

southeastern louisiana university
7 days ago — The final consideration is the total premium rate. The Bidder to respond...
Learn more
Frequently Asked Questions About Benefits at SLU
Find answers to frequently asked questions about benefits for Saint Louis University...
Learn more
POLICIES AND PROCEDURES FOR THESIS, PROJECT, ...
Beginning with Fall 2011, all theses, projects, and dissertations are submitted...
Learn more

Related links form

NEUROLOGY CLINICAL EVALUATION EXERCISE NEX V1 Welcome To The EUREKA Project Formversion 301111 Otsego County Animal Response Team OCART Tier 3 Account

Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period. There are 4 basic types of qualifying life events.

Below is a list of the qualifying life events: Gaining a dependent or becoming a dependent through birth or adoption. Getting married. Applicant or dependent lost minimum essential coverage due to termination or change in employment status.

Qualifying Life Event. Qualifying life events consist of both family changes and employment changes. Outside of open enrollment periods, you may be able to make benefit-election changes if a qualifying life event occurs. This is known as a special enrollment period.

Qualifying events mean you can change your health insurance outside open enrollment. This includes losing your current coverage, moving states, getting married or having a kid.

If you choose to waive the UHP, you must go to .aetnastudenthealth.com/slu to submit a waiver request. Please have your insurance card and policy information available, as you will be asked specific questions about your insurance coverage.

You qualify for a Special Enrollment Period if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Get form
If you believe that this page should be taken down, please follow our DMCA take down processhere.

Industry-leading security and compliance

US Legal Forms protects your data by complying with industry-specific security standards.
  • In businnes since 1997
    25+ years providing professional legal documents.
  • Accredited business
    Guarantees that a business meets BBB accreditation standards in the US and Canada.
  • Secured by Braintree
    Validated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.
Get Student Continuation Coverage Payment Receipt - Slu
Get form
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232