Insurance Form Uf

The policy year begins on august 14 and terminates on the same date the next year.

Insurance form uf. You should remember that your policy is a contract between you and your insurance company and that you have the final responsibility for payment of your med bill. As of may 2016 uf health compliance handles all university of florida requirements regarding immunizations and health insurance. Physical address 1908 stadium rd yon hall rm249 gainesville fl 32611 phone 352 294 2925. Before logging in call your insurance company to review the requirements.

Page 1 of 7 omb no. Uf health is responsible for submitting bills to your insurance company and will do everything possible to expedite your claim. Important forms information patient data form consent and authorization must be signed by parent guardian if student under 18 current shcc patients. Enrollment may be arranged within the first 30 days of a semester.

I apply for a period of disability and or all insurance benefits for which i am eligible under title ii and part a of title xviii of the social security act as presently amended. Patient financial services will contact you if there is an issue with any information provided. Insurance and liability the insurance office serves as the liaison with the department of financial services dfs and the department of management services dms for issues related to insurance. Complete the electronic online insurance verification form below.

Enrolling in the uf insurance plan enrollment deadline. Unless otherwise noted all sections are required. Tips for waiver completion if you have medicaid medicare or tricare or your insurance does not have numbers for the fields requested enter 99999 or n a in the field s. For more information and to complete the official uf forms visit healthcompliance shcc ufl edu.

Visit uf s health compliance website for current information and deadlines related to the university insurance requirement. Coordination of benefits cob. Uf s insurance coverage is through the state risk management trust funds chapter 284 part ii section 768 28 and florida statutes which provides bodily injury and property damage liability insurance for the negligent acts or omissions of our employees and designated volunteers in the course and scope of employment. Form ssa 16 06 2018 uf discontinue prior editions social security administration.

Upload a copy of the front and back of the insurance card where indicated.