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Graduate Appointee Insurance Program (GAIP)
Forms and Publications

All documents are in PDF format.

Address Updates
Benefit Booklet & Summaries

View the Benefit Booklet at the LifeWise website.

Other publications:

Claims & Other Forms

View list of LifeWise forms including claim forms:
http://student.lifewiseac.com/uw/gaip/Forms.aspx

 

Dependent Enrollment Forms

The following forms are available at the LifeWise website under "Dependent Forms":

  • Enrollment and Change Form
    Update member information such as address or remove a dependent from coverage on your plan.
  • Tax Status Declaration
    Declare your tax status when adding a domestic partner for coverage on your plan. This form is required to add a domestic partner.
  • Dependent Verification
    List of documentation required when adding dependents for coverage on your plan.
  • Determine Dependent Status Worksheet
    Determine the correct tax status to declare on the Tax Status Declaration form when adding a domestic partner for coverage on your plan.
  • Marriage Declaration
    Use this form when adding a spouse or domestic partner for coverage on your plan. This is a required form to add these dependents.
Mail Order Forms
Medical Plan Network Providers
Petition Forms
Temporary ID card

LifeWise ID cards are issued within a few days of enrollment. You may also download and print a temporary, personalized ID card from the LifeWise website, or contact LifeWise for further assistance.

GAIP
Topics