RUTGERS UNIVERSITY

2017-2018 Student Health Insurance Plan

F AND J RUTGERS SPONSORED VISA STUDENTS SUMMER ENROLLMENT FORM

NOTE:  THIS FORM IS FOR NEW SUMMER STUDENTS ONLY.  

All F1,J1 Rutgers Sponsored Visa Students are required to enroll in this insurance plan and the premium is added to your term bill, unless proof of health insurance that meets or exceeds the University's minimum required level of coverage is furnished. Students must actively attend classes for at least 31 days after the date for which coverage period is purchased. 

The Summer semester Student Health Insurance Plan is effective May 26, 2018 - August 14, 2018. 

To avoid delay in access to the Rutgers Plan, you must fill out this International Enrollment Form.


To continue the enrollment process, please fill out the required fields below:

ONCE ENROLLED IN THE STUDENT HEALTH INSURANCE POLICY, COVERAGE CANNOT BE CANCELLED AFTER THE ENROLLMENT DEADLINE OR CLAIMS HAVE BEEN PAID BY UNITED HEALTHCARE, WHICHEVER COMES FIRST.

Asterisk (*) denotes required field

STUDENT INFORMATION

 
first name: *
last name: *
student ID: *
date of birth: * (MM/DD/YYYY)