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Rhode Island College
Student Health Insurance Plan

2025-2026 Policy Year
Voluntary Student Enrollment Form

ENROLLMENT DEADLINE: SEPTEMBER 22, 2025

This form is for eligible part-time, non-degree and graduate domestic students carrying a minimum of six (6) credit hours who are not automatically charged for fall coverage but meet eligibility requirements to enroll.

Eligibility will be confirmed with the school prior to processing.

TO CONTINUE THE ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:

Important: Please enter your 7-digit RIC Student ID number with the leading zero in the Student ID field below.  If you do not have this number, please contact the Rhode Island College Bursar's Office.

Asterisk (*) denotes required field

STUDENT INFORMATION

 (7 digits including leading zeros)
 (MM/DD/YYYY)