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ADULT DEPENDENT DECLARATION




  • Insurance

Action: To add a Qualified Adult Dependent, as defined by the Montana University System to medical/dental/vision/optional life insurance/optional AD&D effective the date of notarized Declaration of Adult Dependent Form.
    Forms »
Choices Enrollment Form
Declaration of Adult Dependent Form
  • Beneficiary Changes

Action:You may wish to reassign beneficiary status for the following:
    Basic Life/AD&D » use the reverse side of the Choices Enrollment (In office pick-up).

QUICK QUESTIONS




We've got the answers to your questions concerning, Insurance Group Numbers, Care Provider Networks, Coverage ID Cards, and more. Please visit the Quick Questions site.

For additional information or assistance regarding all benefits, please contact:

Rita Garland
Benefits Services
406.243.4238
406.243.6095 FAX

Human Resource Services

Emma B. Lommasson Center
Room 252

The University of Montana

Missoula, MT 59812

Phone: 406-243-6766

Fax: 406-243-6095