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Dental Insurance
(For Massachusetts Students Only)

Dental insurance plans for students attending Massachusetts colleges and universities and their dependents.

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Vision Insurance

Vision insurance plan for students attending colleges and universities and their dependents.

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Renters Insurance

Assurant offers a variety of coverage options to meet your lifestyle and is able to deliver proof of coverage straight to your landlord.

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REQUEST AN INSURANCE ID CARD

Your card will be sent to the address provided on this form. Please allow 7 - 14 business days to receive your new card.

An asterisk (*) denotes a required field.

First Name:

Last Name:

Student ID:

Date of Birth:

(MM/DD/YYYY)

Email Address:

Address:

Address (cont.):

City:

State:

Zip Code:

Please note, if the address provided is different from what
is currently on file, your address will also be updated.