Rutgers Biomedical and Health Sciences

2021-2022 Student Health Insurance Plan
DEPENDENT ENROLLMENT

SUMMER I NEW STUDENT ONLY

Students who have confirmed their own enrollment in the RBHS Student Health Insurance Plan (SHIP) may use this form to add eligible dependents to the plan. Eligible dependents are the spouse, domestic partner, or child(ren) of a RBHS student who is also enrolled in the SHIP. Students who are not currently enrolled in the SHIP may not purchase coverage for their dependents.

The Dependent Enrollment Deadline is May 31, 2022.


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

Asterisk (*) denotes required field

STUDENT INFORMATION

 (MM/DD/YYYY)