Thomas Jefferson University
STUDENT HEALTH INSURANCE PLAN

Medical Student Leave of Absence Enrollment Form
2024-2025 Academic Year

Medical students who are on an approved leave of absence for personal, academic, research, medical, mandatory medical, or administrative reasons and wish to continue coverage under the Student Health Insurance Plan are eligible to continue coverage under the Jefferson SHIP for one year. Please note: Eligibility will be confirmed with Jefferson prior to enrollment being processed.  

A letter/form of approval is required from the registar's office in order for the enrollment to be processed. The letter/form of approval must be uploaded. If it is determined that you do not meet the eligibility requirements, your enrollment will not be processed. Once eligibility is confirmed, the premium will be added to your student account. Students are enrolled in annual coverage and the premium is charged to your student account by semester.

The deadline to enroll is August 15, 2024. 

TO CONTINUE THE ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW: