RUTGERS UNIVERSITY

2025-2026 Student Health Insurance Plan
FALL DEPENDENT ENROLLMENT FORM

Students who have confirmed their own enrollment in the Rutgers University Student Health Insurance Plan (SHIP) may use this form to add eligible dependents to the plan. Eligible dependents are the spouse, Civil Union Partner, or child(ren) of a Rutgers student who is also enrolled in the Student Health Insurance Plan. 

If you are an International student on an F OR J Rutgers sponsored visa or a visiting scholar please reach out to The Center for Global Services by calling (848) 932-7015 to check eligibility. Your dependent's enrollment will not be processed by completing this form. 

The rates below do not include the student premium. 

Full-Time Dependent(s) (8/15/2025 - 1/14/2026)
Spouse/Civil Union Partner - $1,233.00
Each Child - $1,233.00
Two or More Children - $2,466.00
All Dependents (Spouse/Civil Union Partner and Two or More Children) - $3,699.00

Part-Time Dependent(s) (8/15/2025 - 1/14/2026)
Spouse/Civil Union Partner - $3,032.50
Each Child - $3,032.50
Two or More Children - $6,065.00
All Dependents (Spouse/Civil Union Partner and Two or More Children) - $9,097.50

UnitedHealthcare reserves the right to adjust the terms of the policy (i) in the event of any changes in federal, state or other applicable legislation or regulation; (ii) in the event of any changes in Plan design required by the applicable state regulatory authority; and (iii) as otherwise permitted in the our policy.

DEADLINE: All Dependent enrollments must be submitted by September 25, 2025.