MGH INSTITUTE OF HEALTH PROFESSIONS
Student Health Insurance Plan

QUALIFYING EVENT ENROLLMENT FORM
2016-2017 Policy Year
(May 1, 2016, through April 30, 2017)

The Qualifying Event Enrollment Form is only for students who have previously submitted a waiver form for the 2016-2017 policy year.

The Qualifying Event Enrollment Form is used in the following situations:

  • You previously submitted a waiver form for the 2016-2017 policy year, but now your other health insurance coverage has ended or will be ending and you need to enroll in the SHIP.
  • You are currently enrolled in the SHIP, but your spouse and/or child(ren) have recently experienced a qualifying event (such as birth, marriage, loss of other coverage, or entry into the U.S.) and need to be added to your plan.

IMPORTANT: If you have not yet submitted an online waiver or enrollment form for the 2016-2017 policy year and would like to enroll in the student health insurance plan, you need to submit the online enrollment form. The Qualifying Event Enrollment Form is only for students who have previously submitted a waiver form for the 2016-2017 policy year.