| IMPORTANT REQUIREMENT REGARDING ENROLLMENT
If you are interested in enrolling in the graduate healthcare program, please make note of this very important message…
Separate checks made payable to each vendor are now required with your enrollment form
- If you are enrolling in the UPMC medical plan: make checks payable to “UPMC Health Plan”
- If you are enrolling in the vision plan: make checks payable to “Davis Vision”
- If you are enrolling in the dental plan: make checks payable to “United Concordia”
Checks must be made payable to the appropriate vendor for the ANNUAL PREMIUM amount for each vendor (refer to the new insurance rates located at http://gradcare.hr.pitt.edu/med.htm)
Example: If you want medical coverage from September 1, 2007 through August 31, 2008 for an individual – the monthly premium is $223.01 x 12 months = $2,676.12 total check amount made payable to UPMC Health Plan
Please make notice of this to avoid any delays/problems with coverage.
The deadline to submit enrollment forms is Monday, August 20, 2007.
Submit your enrollment form and separate checks to:
- Nicole Gannon
239
Victoria Building
3500 Victoria Street
Pittsburgh, PA 15261
SPECIAL INSTRUCTIONS
If you are making an election to cover for the FIRST time a spouse, domestic partner, or child(ren) with medical, vision and/or dental coverage, documentation of the relationship is required.
- For a spouse, include a copy of a marriage certificate
with the enrollment form, otherwise your election will not
be put into effect.
- For dependent child(ren), include a copy of the birth
certificate(s), otherwise your election will not be put into
effect. Paperwork for adopted children or stepchildren
is also applicable.
- For a domestic partner, contact the Office of Human Resources
Benefits Department at (412) 624-8050 to schedule an appointment
for review of a completed Affidavit of Domestic Partnership,
and documentation for dependent children, (which may require
adoption paperwork) along with an enrollment form.
- If you are making
an election to delete a spouse or domestic partner because
of the end of a relationship, a copy of a divorce decree
or dissolution form is required.
Additional Graduate Links
|
