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St. John’s University
2024-2025 Policy Year
Student Health Insurance Plan
Non-Resident Graduate Student
Voluntary Annual Enrollment Form


This form is for eligible non-resident domestic students only.  Eligible domestic students living off campus are not assessed the insurance charge on their student account. These students are eligible to enroll voluntarily on-line by submitting the voluntary student enrollment by the posted deadline.

If you are an eligible registered domestic student living off campus for the fall 2024 semester and do not elect to enroll by the fall deadline, you will not be eligible to enroll for the 2024-2025 policy year. Late enrollment will not be accepted unless due to a qualifying life event (ie. loss of other coverage).

In order to successfully complete the below enrollment form you will need to provide your Student ID number beginning with the letter "X". Please do not use the number that starts with "9". This will result in a delay in the processing of your enrollment. If you do not have the student ID number that begins with "X", please contact St. John's University Customer Service at 718-990-2000. 

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)