Changes To Enrollment

Use the Student Medical Insurance Enrollment Change Form if you wish add dependents to, or drop dependents from, your student medical insurance plan. You'll find the complete enrollment change policy documented on the form itself.

• For the August 1, 2009 through July 31, 2010 academic year, complete the 09-10 Medical Enrollment Change form (.pdf).

If you are cancelling yourself and all dependents, use the Student Medical Insurance Enrollment Cancellation form instead.