Enrollment Periods
The Fall open enrollment period to enroll dependents is 6/1/19 – 9/16/19.
The Spring/Summer open enrollment period to enroll dependents is 11/1/19 – 1/13/20.
The Summer open enrollment period to enroll dependents is 4/1/20 – 6/15/20.
Enrollment Forms
- Enrollment Form - Medical, PA and Dental Student Dependents - Annual/Fall 2019-2020 Coverage
- Enrollment Form - SON, SHP, GSBS, Undergraduate and Graduate Dependents - Fall 2019-2020 Coverage
- Enrollment Form - Continuation
- Qualifying Event Enrollment Form - Use only for a life event (aging off parent's plan, marriage, divorce, newborn, adoption of child). Supporting documentation is required.
- Student Turning Age 19 Qualifying Event Form (DENTAL ONLY) - Use only for a life event (aging off parent's plan, marriage, divorce, newborn, adoption of child). Supporting documentation is required.
Additional Vision Coverage
This service is not administered by Academic HealthPlans.