Ub Life Insurance Form

Enroll in health insurance through ub as a domestic student full time or part time.

Ub life insurance form. First year and transfer students overview step 1. Domestic student health insurance enrollment form. To begin the waiver process have your ub person number and your insurance card ready then complete the waiver form on the haylor freyer and coon inc. It s printed with red ink on white standard paper.

This enrollment form must be submitted on line by the specified date or within 30 days of a qualifying event such as marriage birth of a child loss of other coverage. Complete the orientation data form. Bankers life is the marketing brand of bankers life and casualty company medicare supplement insurance policies sold by colonial penn life insurance company and select policies sold in new york by bankers conseco life insurance company bclic. Sample ub 04 forms for inpatient and outpatient claims can be found on pages 3 and 4.

If you did not yet read the informational insurance information. The ub 04 uniform billing form is the standard claim form that any institutional provider can use for the billing of medical and mental health claims. The ub 04 claim form and npi the ub 04 claim form includes several fields that accommodate the use of your npi. The ub 04 claim form accommodates the national provider identifier npi and has incorporated other important changes.

Insurance is also available for students faculty and staff who are going abroad. When you have completed the process successfully you will be sent an email with a confirmation number. You will only be permitted a waiver of the cost of the suny health insurance if your policy matches or exceeds the policy available through suny and is approved by ub s student health insurance office. Student life 520 capen hall university at buffalo buffalo ny 14260.

If you did not yet read the informational insurance information please do that before completing and submitting this form. Although developed by the centers for medicare and medicaid cms the form has become the standard form used by all insurance carriers. New to ub programs will introduce you to life on campus and prepare you for a successful start at ub.