BSU_LOV_SPG11 - VERIFICATION OF COVERAGE SPRING 2011*TO BE...

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VERIFICATION OF COVERAGE – SPRING 2011 *****TO BE COMPLETED BY THE INSURANCE COMPANY OR REPRESENTATIVE***** In order to waive coverage under the Boise State University Student Health Insurance Plan (SHIP), students must provide proof of coverage under a plan of coverage, with eligible effective dates. Such coverage must include: a) a deductible of $5000 or less, and b) a per condition maximum of $100,000 or more. Effective dates are 1/15/11 through 5/13/11. Insurance Carrier/Company Representative: Please complete and sign the form below, and return to Insured. (Confirmation Letter of Verification on Company letterhead, or Certificate of Credible Coverage will also suffice) Student: Scan and upload the form, following the Waiver Instructions, at: www.renstudent.com/bsu or FAX to 877-778-6787 by the Deadline of January 31, 2011. If you have questions, you may call Renaissance Insurance Agency at (800) 537-1777 between 8:00am and 5:00pm, Pacific Standard Time, Monday through Friday. I certify that __________________________________________ is currently covered under
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This note was uploaded on 01/18/2012 for the course ENGLISH 102 taught by Professor Bailey during the Fall '11 term at Boise State.

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BSU_LOV_SPG11 - VERIFICATION OF COVERAGE SPRING 2011*TO BE...

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