VEHI Health Plans » Health Insurance Forms – 2020

Health Insurance Forms – 2020

The Enrollment and Change form is to be used for a new enrollment effective 1/1/2020 or later, change in marital status, change a health coverage tier, adding or deleting a dependent, cancel coverage after 1/1/2020, COBRA election, etc. Please note: Social Security Numbers are required for ALL members (includes dependents).

Declaration of Health Care Coverage form