Get Ucb Waiver Form 2009-2010.doc - Uhs Berkeley

Filling out the UCB Waiver Form for the 2009-2010 academic year is an essential step for students seeking to waive their health insurance fee. This guide provides clear, step-by-step instructions to ensure that you complete the form accurately and submit it on time.

Follow the steps to complete the waiver form seamlessly.

1. Click the ‘Get Form’ button to access the waiver form and opens it in your document editor.
2. Begin by filling out the student information section. Indicate your current registration status by checking the appropriate box. Provide your student identification number, date of birth, last name, first name, middle initial, address, city, state, zip code, and telephone number.
3. Move to the health insurance plan benefit information section. Fill in the insurance company name and phone number, the policy holder’s name along with their identification number, and their relationship to you.
4. Specify whether the plan is a self, spouse/domestic partner, parent, group, or individual/family plan. If it's a group plan, include the employer's name and the name of a healthcare facility within 25 miles of Berkeley.
5. In the health insurance plan benefit information part, provide detailed responses regarding your plan's benefits, including maximum lifetime benefit, annual deductible, coinsurance percentage, inpatient mental health services, and worldwide coverage.
6. Certify the accuracy of the information provided by signing the form. Include your email address and the date on which you complete the form.
7. Keep a copy of the completed form for your records. Submit the signed waiver form by mailing it or delivering it in person to the Student Health Insurance Office at the specified address.
8. Ensure that the waiver is submitted before the deadline of July 15, 2009, to avoid a late fee. If your submission is approved, keep in mind that the waiver is valid for the entire academic year.
9. After completing all sections, save any changes if applicable, download the form, print it, or share it as needed.

Start completing your UCB Waiver Form online today to secure your health insurance waiver.