Thursday, May 23, 2013   
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Download Forms » Download Extension of Coverage Forms  
 Dates and Premiums    
Plan Coverage Dates
Fall 2012 8/21/2012-1/11/2013
Spring 2013 1/12/2013-5/10/2013
Summer 2013 5/11/2013-8/20/2013
 

Enrollment/Change Periods

Fall 2012

8/27/2012-9/25/2012

Spring 2013

1/14/2013-2/22/2013

Summer 2013

5/13/2013-6/24/2013

 

Continuation of Coverage Enrollment
Fall 2012 7/23/2012-9/25/2012
Spring 2013 12/03/2012-2/22/2013
Summer 2013 4/15/2013-6/24/2013
 

Premiums Per Semester
Fall 2012 - Summer 2013

 

Undergrad

 Graduate
Student

$219

$310

Spouse

$1003

$1309

Children

$463

$652

 

Premiums Per Semester
Fall 2011 - Summer 2012

 

Undergrad

 Graduate
Student

$219

$310

Spouse

$901

$1253

Children

$416

$624

 

   
      

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 Extension of Coverage form is now only available under the Online Enrollment & Payment tab, during the Extension Enrollment  Periods listed on the left panel of the site.


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