MCPHS UNIVERSITY
STUDENT HEALTH INSURANCE PLAN
2025-2026 Annual
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, 2025.
TO CONTINUE THE DEPENDENT ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:
