THE NEW SCHOOL
STUDENT HEALTH INSURANCE PLAN
2025-2026 POLICY YEAR
DEPENDENT ENROLLMENT FORM
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. If an enrollment form is submitted and the dependent is not eligible, it will not be processed.
If your dependent has experienced a qualifying life event (ie. loss of other coverage, recent marriage, birth, etc.) please contact University Health Plans at info@univhealthplans.com or 833-251-1129.
The deadline to complete this enrollment form is September 9, 2025.
PLEASE FILL OUT THE REQUIRED FIELDS BELOW TO CONTINUE THE DEPENDENT ENROLLMENT PROCESS: