Monday, November 23, 2009   
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Forms » Download Enrollment/Change Period Forms  
 Dates and Premiums    
Student Insurance Plan
Coverage Periods

Summer 2009   5/16/2009-8/21/2009
Fall 2009 8/22/2009-1/15/2010
Spring 2010 1/16/2010-5/14/2010
Summer 2010 5/15/2010-8/20/2010
 

Enrollment/Change Periods

Summer 2009

5/18/2009-6/22/2009

Fall 2009

8/24/2009-9/23/2009

Spring 2010

1/19/2010-2/22/2010

Summer 2010

5/17/20010-6/22/2010

 

Extension Enrollment
Summer 2009   4/13/2009-6/22/2009
Fall 2009 7/13/2009-9/23/2009
Spring 2010 12/01/2009-2/22/2010
Summer 2010 4/12/2010-6/22/2010
 

Premiums Per Semester
Fall 2009 - Summer 2010

 

Undergrad

 Graduate
Student

$206

$292

Spouse

$849

$1181

Children

$392

$589

 

Premiums Per Semester
Fall 2008 - Summer 2009

 

Undergrad

 Graduate
Student

$197

$279

Spouse

$836

$1164

Children

$386

$580

 

   
      

Student Insurance Forms require Acrobat Reader, a free download from Adobe Systems.  Get it here.  

All forms printed from this website must be mailed or faxed to the Student Insurance office. Students wishing to come in person will be required to use different forms. To avoid long lines in our office, it is strongly suggested that students submit the forms by mail or fax.


Please note that Exemption Application, Extension of Coverage, Dependent Coverage, Deadline Extension and Special Groups forms are only available to download during the Enrollment/Change Periods listed on the left panel of the site.  If the forms are available, you will see them in a section below entitled Enrollment/Change Period Forms.


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