Graduate Health Insurance Forms


RFGI-1 GSEHP Enrollment Form

RFGI-2 New Employee Orientation Checklist

RFGI-3 Health Insurance/Prescription Drug Information FAQ

RFGI-4 Graduate Student Summary of Benefits

RFGI-5 Graduate Student Employee Health Plan

RFGI-6 Graduate Student Employee Dental Plan

RFGI-7 Graduate Student Vision Brochure

RFGI-8 Domestic Partner

RFGI-9 Benefit Plan Affidavit of Domestic Partnership

RFGI-10 Affidavit of Financial Interdependency

RFGI-11 Dependent Tax Affidavit for Enrolling Domestic Partner in the Benefits Program

RFGI-12 Proof of One Year Residency

RFGI-13 Statement of Dependence of Domestic Partner’s Child for Participation in the RF Health Insurance Plan

RFGI-14 Termination of Domestic Partnership

RFGI-15 Prescription Drug Reimbursement Form

RFGI-16 Health Insurance Claim Form

RFGI-17 Health Insurance Portability and Accountability Act

RFGI-18 Authorization for Health Care/Health Insurance Advocacy

RFGI-19 Dental and Vision Information FAQ

RFGI-20 Delta Dental