Indiana University

Semester Enrollment Form

Visiting Scholars may enroll themselves and their eligible dependent(s) in semester-based coverage within 30 days of their eligibility. Payment can be made in full or through an automatic payment plan.

Custom Date Enrollment Form

Visiting Scholars can enroll themselves and their dependent(s) in a custom coverage period. Payment must be made in full for the coverage period elected.

Qualifying Life Event Enrollment Form

If you did not enroll your dependent(s) during with your initial enrollment, they may be eligible for a special enrollment period if they experience an IRS-qualifying life event.