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SALEM STATE UNIVERSITY
STUDENT HEALTH INSURANCE PLAN

2024-2025 POLICY YEAR
Spring Termination Request Form

Massachusetts Student Health Insurance Regulations allow students who paid for the Student Health Insurance Plan (SHIP) for the full 2024-2025 policy period to request termination for the spring coverage period if they are in one of the following situations:

  • Not returning to their college or university for the spring semester
  • Obtained coverage through MassHealth or a subsidized connector care plan on or before 1/1/2025

Only students in one of the two situations above can use this form. Students newly eligible for a private insurance plan are not eligible for a spring termination request. Students ineligible for a spring termination request remain enrolled through 7/31/2025.

Spring Termination Form Deadline January 31, 2025.

Asterisk (*) denotes required field

 (MM/DD/YYYY)