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Emerson College
STUDENT HEALTH INSURANCE PLAN

Qualifying Event Enrollment Form
2024-2025 Academic Year

qualifying life event makes you eligible for special enrollment rights to enroll in the student health insurance plan outside of your initial eligibility period. 

Eligibility will be verified with Emerson before enrollment is processed. Online-only students are not eligible for the plan.

Loss of Coverage
  • If your other insurance coverage has recently ended or is about to end
  • If your plan no longer includes Boston, MA, in its service area

Required Documentation: You must provide a loss of coverage letter that includes the student's name and specifies the date the coverage ends or documentation showing that the plan no longer covers the student in Boston, MA.


Moving to or From School

  • If the student was studying abroad or away from the Boston Campus during the fall semester, the student may enroll in spring coverage upon returning to campus for the spring semester.

  • If the student studied on the Boston Campus during the fall semester and will study abroad or away from it during the spring semester, the student may enroll in the spring coverage period if their personal insurance does not cover them where they will live. 

Required Documentation: Provide documentation or a letter confirming the location where the student studied during the fall semester or documentation confirming the student will be studying away from campus for the spring semester. 

 

The deadline to enroll is 60 days from the qualifying life event. 

 

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)