BRIDGEWATER STATE UNIVERSITY
STUDENT HEALTH PLAN
2018-19 SPRING SEMESTER

Spring Semester Enrollment Form

In order to ensure that all full time and three quarter time college students have adequate medical insurance while pursuing their academic goals, state law requires that students have coverage, either through the Bridgewater State University Student Health Plan or another United States-based carrier offering comparable coverage.

To waive the University's Student Health Plan, you may provide proof of your comparable coverage by completing a Waiver Form (see link under the menu to the left).

To confirm your enrollment in the University's Student Health Plan, you may continue using this form. Enrollment information for students who complete an online Enrollment Form may be sent to University Health Plans/BCBS earlier than the waiver deadline.

Failure to complete an online enrollment form and/or failure to confirm payment with Student Accounts will delay your enrollment in the school sponsored plan.  You will still remain responsible for teh full health insurance premium charged to your student account.


To continue the enrollment process, you will need your Banner ID number which can be found on your tuition bill. This ID number is not your social security number nor your Connect Card number. Please enter your Banner ID below.

By continuing the enrollment process, you are confirming that: (1) you want to be enrolled in the Student Health Plan provided by Bridgewater State University; and (2) you understand that you will be held responsible for the insurance premium of $1,748 that has been charged to your student account.

date of birth: (MM/DD/YYYY)
Banner ID: