Eligibility Forms

Full-Time Student Status Verification (English) This form is to be completed and returned to PAI to verify the status of dependents who are full-time students enrolled in an accredited college or university.

Estudiante de Tiempo Completo Solicitud de Condición (Español) Esta forma deberá ser completada y deberá ser vuelta a PAI para verificar la posición de los dependientes que son estudiantes de jornada completa matriculados en un colegio o la universidad acreditados.

Termination/Involuntary Loss of Coverage Form

Missed Premium Direct Payment Form

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