Wake Forest School of Medicine
STUDENT HEALTH INSURANCE PLAN

Qualifying Life Event Enrollment Form
2024-2025 Academic Year

If you have a life event outlined below, you may qualify for special enrollment rights to enroll in the student insurance plan outside the initial enrollment period. 

Loss of Other Coverage:

• Required Documentation: a letter or certificate from your prior insurance company or employer that clearly indicates your name and your last day of coverage under your prior plan. If your plan’s coverage area recently changed, and you no longer live in the coverage area, you must include a letter or certificate from your prior insurance company or employer confirming the change in network coverage area.
• Deadline: within 30 days of your loss of other coverage or the date you no longer lived in your plan’s coverage area.
• Effective Date of Coverage: the first day without coverage under your prior plan or the date you no longer lived in the plan’s coverage area.

Change in Household

• Required Documentation: marriage certificate, birth certificate, passport stamp entering the US
• Deadline: 30 days from date of marriage, birth, or entry into the US
• Effective Date of Coverage: date of marriage to the student, date of dependent's birth, or date dependent moves to the US