MCPHS University
STUDENT HEALTH INSURANCE PLAN

Annual 2024 - 2025
Dependent Enrollment Form
 

Dependent coverage, if elected, begins and ends with the student’s coverage and must be purchased at the same time the student enrolls in the plan. Students can enroll their dependents using this form. 

The deadline to complete the Dependent Enrollment Form is August 1, 2024.

TO CONTINUE THE DEPENDENT ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW: