Geneva College
STUDENT HEALTH INSURANCE PLAN

Qualifying Event Enrollment Form
2024-2025 Academic Year

A qualifying life event is a change in situation, such as a loss of other coverage, moving from your plan’s service area, getting married, having a baby, or entering the United States that makes you eligible for special enrollment rights.

Students with one of the following qualifying life events may use this form to enroll in the Student Health Insurance Plan while continuing to be active eligible students. Eligibility will be verified with Geneva College before enrollment is processed. Online-only students are not eligible for the plan.

Loss of Other Coverage:

• Required Documentation: Loss of coverage letter that includes your name and your last day of coverage
• Effective Date of Coverage: The first day without coverage in the prior plan

Living Away From Plan's Service Area:

• Required Documentation: If you were insured by a private insurance plan that no longer provides comprehensive benefits in Pennsylvania, documentation is required to confirm the date the plan no longer provides comprehensive benefits in Pennsylvania.  

• Effective Date of Coverage: The date you lost coverage in Pennsylvania via your private insurance plan. 

Enrollment Deadline: The qualifying event enrollment form, payment, and required documentation must be received within 30 days from the qualifying event date.