

Enrollment
The Summer open enrollment period is 04/17/19 – 06/05/19
- Eligibility Guidelines
- Continuation Enrollment Form
- Qualifying Event Enrollment Form - HIMD Students: Use only for a life event (aging off parent’s plan, marriage, divorce, newborn, adoption of child). Supporting documentation is required.
- Qualifying Event Enrollment Form - FSHI Students: Use only for a life event (aging off parent’s plan, marriage, divorce, newborn, adoption of child). Supporting documentation is required.
- GA/TA/RA 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.
Add-On Coverage Options
These services are not administered by Academic HealthPlans.