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

2013 - 2014 School Year Coming Soon!

2012 - 2013 School Year

STUDENT ENROLLMENT INSTRUCTIONS
If you are a…
A student enrolled in 12 credit hours or more you are automatically enrolled in this insurance plan unless proof of comparable coverage is furnished. Please contact your school to enroll.

Annual Enrollment Deadline: 10/13/12
Spring/Summer Enrollment Deadline: 2/8/13

PLEASE NOTE: The Optional Catastrophic Coverage cannot be purchased through the Enroll/Waiver site. For Students to enroll in the Optional Catastrophic coverage, you can enroll on-line under My Account with your credit card or fill out an enrollment form and mail it with your check or money order. The enrollment form with payment must be received in our office within two weeks after enrolling in the basic coverage. On-line enrollment in the Catastrophic coverage must be completed within two weeks after enrollment. If received or completed on-line after the two week grace period, you will not be eligible to enroll in the Optional Catastrophic Coverage and your enrollment form and payment/credit card payment will be returned to you.

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, please CONTACT US

Optional Catastrophic Coverage

Catastrophic Coverage is an additional optional benefit you may choose to purchase, in addition to the basic policy.

Students are eligible to purchase the Catastrophic Coverage benefit for an additional premium.

Students have 2 weeks from the date of their enrollment in the basic program to enroll themselves in the Catastrophic Coverage benefit.

Dependents are not eligible for the Optional Catastrophic Coverage benefit.

For more detailed information on the Catastrophic Coverage benefit please refer to your Brochure.

Please see enrollment instructions below.

Dependents

Students who do enroll may also insure their eligible dependents. Please see Optional Major Medical & Dependent Enrollment Instructions.

Optional Catastrophic Coverage & Dependent Enrollment Instructions

MY ACCOUNT

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. (If you are a Student already enrolled and ONLY need to enroll in the Optional Catastrophic Coverage, you can also enroll through "My Account" if it's within 2 weeks of the enrolling in the basic coverage.)
ENROLL BY MAIL

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 Dependent’s coverage will be the date you enrolled on-line or the date we received the enrollment form with full payment in our office.)

Enrollment Forms

DEPENDENT ONLY ENROLLMENT FORM

Download Enrollment Form

STUDENT ONLY - OPTIONAL CATASTROPHIC COVERAGE ENROLLMENT FORM

Download Enrollment Form

If you have any questions about the enrollment process, please call 1-800-505-4160 or

CONTACT US

We are always happy to help in any way.