UMASS-Dartmouth
Student Health Insurance Plan

2023-2024 Policy Year
Dependent(s) Coverage Enrollment Form

All full-time and three-quarter time graduate and undergraduate students who are enrolled in the Student Health Insurance Plan (SHIP) may choose to enroll their dependents by submitting this dependent enrollment form.The deadline to submit the dependent enrollment form for the 2023-2024 policy year is October 10, 2023. Payment for the dependent insurance charge must be paid at time of enrollment.

Dependent coverage, if elected, begins and ends with the student’s coverage and must be purchased at the same time the student enrolls in the plan. Eligibility will be confirmed. Dependents will not be enrolled until the student has been enrolled. 

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