Eligibility and Insurance - Cal State Long Beach 2025

1. Click ‘Get Form’ to open the Eligibility and Insurance form in the editor.
2. Begin by entering your name, student ID number, telephone number, and email address in the designated fields.
3. 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'.
4. 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.
5. Review the criteria listed for adequate insurance coverage. Ensure you check all applicable boxes confirming compliance with each requirement.
6. Sign and date the form at the bottom to affirm that you are covered by an appropriate health insurance policy.

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