Wellesley College
STUDENT HEALTH INSURANCE PLAN

Annual Dependent Enrollment Form
2025 - 2026 Academic Year

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

Dependent Eligibility: Student's spouse or child(ren) under age 26. If a student enrolls a dependent child who reaches age 26 during the policy year, the dependent child will be terminated at the end of the month in which they reach age 26. Domestic Partners are not eligible. 

Please note, your Wellesley student ID# begins with a "B" or "C" followed by 8 digits. You must use your Wellesley College email address in the email field.