RUTGERS UNIVERSITY

2023-2024 Student Health Insurance Plan
SUMMER DEPENDENT ENROLLMENT FORM

Students who have confirmed their own enrollment in the Rutgers University Student Health Insurance Plan (SHIP) may use this form to add eligible dependents to the plan. Eligible dependents are the spouse, Civil Union Partner, or child(ren) of a Rutgers student who is also enrolled in the Student Health Insurance Plan. 

If you are an International student on an F OR J Rutgers sponsored visa or a visiting scholar please reach out to The Center for Global Services by calling (848) 932-7015 to check eligibility. Your dependent's enrollment will not be processed by completing this form. 

The rates below do not include the student premium. 

Full-Time Dependent(s) (5/26/24 - 8/14/24)
Spouse/Civil Union Partner - $607.00
Each Child - $607.00
Two or More Children - $1,214.00
All Dependents (Spouse/Civil Union Partner and Two or More Children) - $1,821.00

Part-Time Dependent(s) (5/26/24 - 8/14/24)
Spouse/Civil Union Partner - $1,478.00
Each Child - $1,478.00
Two or More Children - $2,956.00
All Dependents (Spouse/Civil Union Partner and Two or More Children) - $4,434.00

DEADLINE: All Dependent enrollments must be submitted by June 30, 2024.

Eligibility will be confirmed with Rutgers prior to enrollment being processed.

To continue the dependent enrollment process, please fill out the required fields below: