Ithaca College
STUDENT HEALTH INSURANCE PLAN

2017-2018 POLICY YEAR
Spring Term Enrollment Form

Submitting the online enrollment form will expedite the processing of your enrollment in the Student Health Insurance Plan. Once you complete the online enrollment form, it will be processed within 3 - 5 business days.  If you are eligible for the plan and do not complete a waiver or enrollment form by the deadline, your enrollment information will not be submitted to University Health Plans until after the waiver deadline.

Students who wish to add dependents will have the option after completing the enrollment form.  Dependent enrollment must be completed at the same time as student enrollment.  Please contact University Health Plans for the dependent enrollment form and rates.

The Spring Term Enrollment deadline date is January 15, 2018.


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

Please Note: You must enter your Ithaca College email address below. Entering your personal email address will not allow you access to the enrollment form. You must activate your Ithaca College Netpass/e-mail account prior to completing this process.

date of birth: (MM/DD/YYYY)
student ID:
email address: