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Eligibility and Insurance - Cal State Long Beach 2026
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- Click ‘Get Form’ to open the Eligibility and Insurance form in the editor.
- Begin by entering your name, student ID number, telephone number, and email address in the designated fields.
- Provide the name of your alternate insurance and the primary subscriber's name. Indicate your relation to the subscriber by selecting either 'Parent' or 'Spouse'.
- Attach a copy of the required documents: (1) Summary of Benefits and (2) Proof of Insurance that includes your name on the policy along with eligibility dates.
- Review the criteria listed for adequate insurance coverage. Ensure you check all applicable boxes confirming compliance with each requirement.
- Sign and date the form at the bottom to affirm that you are covered by an appropriate health insurance policy.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2017 | 4.8 Satisfied (55 Votes) |
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