Please Read the Following Information 

**ALL FORMS MUST BE SUBMITTED TOGETHER BY THE DEADLINES OR THEY WILL NOT BE PROCESSED** 

All required paperwork MUST be submitted within 31 days of a Qualifying Event 

Due to birth and/or adoption, all required paperwork MUST be submitted within 61 days of the Qualifying Event 

How to Complete Add/Drop Coverage Forms (Qualifying Events)

  1. Complete the Enrollment/Drop Form (listed below)
  2. If adding a Spouse/Domestic Partner complete the Declaration of Spouse/Domestic Partnership Form (listed below)
  3. Most changes are effective the first day of the the following month (after event occurs)  
  4. Undergraduate/Graduate students without an assistantship CANNOT drop the dental insurance during the academic year due to the annual premium being paid in full at the beginning of the year/semester.

 

Qualifying Events Supporting Documentation You MUST Provide 
Loss of Coverage

Letter from Former Insurance Provider and/or Employer (Listing: Name, Date of Birth, & LAST day of Coverage)
Newly Eligible for Other Coverage

Letter from New Insurance Provider and/or Employer (Listing: Name, Date of Birth, & FIRST day of Coverage)
Arriving in the U.S. Copy of Stamped Visa/Passport and/or I-94 Travel History 
Departing the U.S. Copy of Stamped Visa/Passport and/or I-94 Travel History 
Marriage  Copy of Marriage Certificate 
Birth  Copy of Birth Certificate