Student / Dependent Enrollment

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Welcome to the Student / Dependent Enrollment Center! We are here to help make enrolling as easy and as painless as possible.

We suggest you review your brochure and rates before starting the enrollment process. The plan’s benefits can be found in the brochure within the Schedule of Benefits section with the exclusion towards the back.

View your  brochure

2014 - 2015 School Year

If you are a full-time medical student you are automatically enrolled in this insurance Plan, unless proof of comparable coverage is furnished

ENROLL NOW IN COVERAGE ON-LINE. (Hard waiver students only)
  • Annual Enrollment Deadline: 8/15/14

If you have missed the hard waiver enrollment deadline, but have not previously waived out of the insurance, you will be automatically enrolled in the insurance by your school.
If you have previously waived out of the insurance and would like to enroll or if your non-school sponsored coverage is being terminated and you are now looking to enroll in the
Student Injury & Sickness plan,



Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the student’s spouse and dependent children under 26 years of age. Please see Enrollment Instructions for Dependents Coverage below.

Enrollment Instructions for Dependents Coverage



Full-Time Students: If you are already enrolled and only need to enroll your dependents, you will need to create a “My Account”. Once you are logged in, you may enroll your dependents by clicking on the “Dependent Enrollment” button on the My Account page. This will allow you to enroll your dependents without being charged a second time for the student premium. 


To enroll by mail-download an enrollment form and submit by mail using a check or money order. The mailing address is listed on the back of the Enrollment Forms.

(The effective date of your coverage will be the date you enrolled on-line or the date we received the enrollment form with full payment in our office.)

Open Enrollment Periods

IMPORTANT INFORMATION: Open Enrollment Periods for all Dependents and Students: If you have eligible Dependents in the fall or, are a student in the fall semester and eligible to purchase coverage and you choose not to enroll for coverage before the Fall Enrollment Deadline of *August 15, 2014, your Dependents or you, will not be eligible to enroll again until the start of next fall unless you experience a “Qualifying Life Event” during the year. A Qualifying Life Event includes marriage, divorce, birth of a child or loss of coverage through no fault of your own (i.e. aging of your parents coverage).If your Dependents or you, experience a “Qualifying Life Event”, you must submit proof of the event and enroll within 30 Days of the event, otherwise you will no longer be eligible to enroll for the remainder of the policy year.

Qualifying Life Event

If you did not enroll, or did not enroll your dependents (dependents of hard waiver or voluntary students) during your open enrollment period and have since lost coverage under your original plan, you or the dependents may qualify for a Qualifying Life Event, upon providing proof of involuntary loss of coverage and payment, within 30 days of losing coverage. (example: marriage, divorce, loss of job, etc) The enrollment form, check or money order and the letter of creditable coverage, must be received within 30 days of losing coverage. After 30 days, the student or dependents will no longer be eligible to enroll in the plan, until fall of the following school year.

Please contact us at CONTACT US for cost and enrollment information as a Qualifying Life Event.

Enrollment Forms





If you have any questions about the enrollment process, please call 800-505-4160 or

 We are always happy to help in anyway.