Stevens Institute of Technology

2024-2025 Student Health Insurance Plan
SPRING DEPENDENT ENROLLMENT FORM

Students who have confirmed their own enrollment in the Stevens Student Health Insurance Plan (SHIP) may use this form to add eligible dependents to the plan. Eligible dependents are the spouse, domestic partner (same-sex, opposite sex), and child(ren) up to the age of 26 of a Stevens student who is also enrolled in the SHIP. Students can enroll an unmarried and over age 26 dependent child up to the age of 31, as long as they are a full-time student, at an accredited institution of higher education and solely depends on student support. Students who are not currently enrolled in the SHIP may not purchase coverage for their dependents.

To continue the enrollment process, please fill out the required fields below: