Suffolk University
STUDENT HEALTH INSURANCE PLAN

Qualifying Event Enrollment Form
 

A qualifying event is an event like losing health coverage, getting married, having a baby, or entering the US. These changes can make you eligible for a special enrollment period, allowing you to enroll in the student health insurance outside the open enrollment period. 

Enrollment Deadline: The qualifying event enrollment form, payment, and required documentation must be received within 60 days from the qualifying event date. 

You can use this form to enroll in the Suffolk University Student Health Insurance Plan. Please contact University Health Plans at 800-437-6448 if you have a qualifying event not listed below.

Loss of Other Coverage (losing health coverage through employer, parent's plan, or Medicaid)

Changes in Residence (entry into the US or moving out of existing coverage area)

All qualifying events require documentation to provide proof of your qualifying event. If you have questions about the documentation required, please contact University Health Plans at 800-437-6448 before you submit your enrollment form.