MGH INSTITUTE OF HEALTH PROFESSIONS
Student Health Insurance Plan

2019 Fall Term Enrollment Form


This enrollment form is for New Degree/Certificate Students for the Fall 2019 Term.

The enrollment deadline date for Fall Term is September 1, 2019.


(Enrollment Period of 09/01/19-04/30/20)

NOTE:  If you will graduate in September of 2019, this coverage will be effective until August 31, 2019.  If you will graduate in January of 2020, this coverage will be effective until December 31, 2019.

 

Asterisk (*) denotes required field

STUDENT INFORMATION

 
 (MM/DD/YYYY)