WWAMI United Healthcare Enrollment Form

WWAMI students are invited to enroll in the UAA Graduate Student Healthcare Benefits Plan. Students may enroll for the academic year (August 25, 2021 to August 24, 2022) or by the month. Monthly benefits begin on the 1st day of the month and extend to the last day of the last month for the coverage period. For example, September 1, 2021 through April 30, 2022.

UAA Student ID Numbers = 8 characters. Do NOT use your UW ID #.

If you do not have a middle name, please enter N/A

MM/DD/19__

Please choose M for male, F for Female. United Healthcare does not have and option for "other" at this time.

Where do you receive your mail? Please include Street, Circle, Drive, Avenue, or PO Box, etc.

Choose: Apt #, Building #, Suite #, Space #, etc.

Enter only 5 digits; not full zip code address.

Format: (XXX) XXX-XXXX

Choose either Annual or Monthly

Date must be the first day of the month

Date must be the last day of the month.