Fully answer each item on page1. If you have not received an insurance card please come to the INTO Suffolk Welcome Desk or call 617-573-8700.Suffolk University must enroll students who are registered in at least 75 percent of a full time curriculum into a health insurance plan. Complete the patient and insured information sections (Boxes 1-12). •. Please print or download form to your computer. Follow the instructions on each form and print or type legibly. Application for a summons DC-430 File with a verified complaint to request the court to issue a summons if you do not have an attorney. Suffolk Public Schools offers its employees two choices of health insurance plans through Anthem Blue Cross Blue Shield.

Letter Insurance Form For Submission In Suffolk

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