MCPHS UNIVERSITY
STUDENT HEALTH INSURANCE PLAN

2025-2026 Spring
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. Students can enroll their dependents using this form. 

This is for new spring students only.  

The deadline to complete the Dependent Enrollment Form is January 31, 2026.

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