UNIVERSITY OF MASSACHUSETTS - LOWELL
STUDENT HEALTH INSURANCE PLAN

Annual Dependent Enrollment Form
2024-2025 Academic Year

Dependent coverage, if elected, begins and ends with the student’s coverage and must be purchased at the same time the student enrolls in the plan.

The deadline to complete the Annual 2024-2025 Dependent Enrollment Form is September 1, 2024. 

Your student ID# must be entered as an 8-digit number