Umass Boston Dependent Health Insurance Form

Coverage is effective the first day of the month following 60 days in an eligible position with employees hired on after july 1 2003 contributing 25 of the total health and basic.

Umass boston dependent health insurance form. Insurance information form pdf complete this form so uhs can bill your insurance company for your care. If your dependent is turning age 26 and is a massachusetts resident he she may purchase health insurance from the health connector 1 877 623 6765. If he she lives out of state contact the health insurance marketplace for coverage information in that state. If dependent is age 19 or over a dependent age 19 or over application form is also required.

Benefited faculty and staff are eligible for health life and long term disability insurance coverage through the massachusetts group insurance commission gic. Bursar s office campus center 4th floor university of massachusetts boston 100 morrissey boulevard boston ma 02125 phone. Umass boston is pleased to announce that for the 2020 2021 academic year we have teamed up with blue cross and blue shield of massachusetts bcbsma to provide health insurance coverage for our students. Employees who do not enroll in a health insurance plan when first eligible may enroll during annual enrollment.

Details about the student health insurance plan shp can be found by selecting benefit information on the left hand. We award financial aid on a first come first served basis so please be prompt. Dependent ages 19 to 26 enrollment change form for more information visit the dependents age 19 26 page at gic. Umass boston student health insurance plan 2020 2021 policy year.

Coverage will begin july 1 following annual enrollment. Forms financial aid may request that you provide additional information to confirm your eligibility for the maximum amount of financial aid you can receive. The umass boston student health insurance plan offered through blue cross blue shield meets shp requirements. Health plan enrollment form pdf complete this form if you want to purchase health insurance coverage for your spouse same sex domestic partner and or dependent children 19 or under.

Dependents turning age 26 health insurance options. Students who are currently enrolled in the university of massachusetts boston student health insurance plan for the current policy year and did not submit a dependent enrollment form by the fall deadline cannot submit a dependent enrollment later in the same academic year unless the dependent has experienced a qualifying event i e loss of other coverage marriage birth entry into the united states.