Indiana University
INTERNATIONAL VISITING SCHOLAR & OPT
INSURANCE PLAN
Qualifying Life Event Enrollment Form
2024-2025 Academic Year
Please read all information before submitting your form.
A qualifying life event is a change in your situation that makes you and/or your dependent(s) eligible to enroll in the insurance plan outside the initial enrollment period. This form can be used in the following situations.
Loss of Other Coverage:
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Required Documentation: letter that includes the insured's name and last day of ACA-compliant coverage
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Effective Date of Coverage: the first day without coverage in the prior plan
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Deadline: 30 days from the last day of coverage in the prior plan
Entry into the US
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Required Documentation: Copy of the I-94 entry form
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Effective Date of Coverage: date of entry into the US
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Deadline: 30 days from the entry into the US
Birth or Adoption:
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Required Documentation: official documentation of the birth or adoption
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Effective Date of Coverage: date of birth or adoption
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Deadline: 30 days from the date of birth or adoption
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Required Documentation: copy of the marriage certificate
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Effective Date of Coverage: date of marriage
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Deadline: 30 days from the date of marriage
