The LOA enrollment form is no longer available.
Student Health Plan
- Waiver Form
- Enrollment Form
- Qualifying Event Enrollment Form
- Insurance ID Card
- Confirmation of Coverage Letter
- Prescription Tier Structure
- 1095-B Form
- Pharmacy Locator
- Worldwide Travel Assistance
Optional Plans
Additional Information
- Jefferson Health & Wellness
- Other Health Insurance Options
- Medical Student Leave of Absence Enrollment Form
Before enrolling, we encourage students to compare all other insurance options. Pennie offers information for Pennsylvania residents about their online marketplace where you can compare and purchase insurance plans. You may be eligible for a Subsidized Health Plan (a low-or-no-cost insurance program for qualifying uninsured adults).
Before accessing the enrollment form, read the following and acknowledge the statements below.
- I have compared all other insurance options and still choose to enroll in the Thomas Jefferson 2024-2025 student health insurance plan.