UNIVERSITY OF MASSACHUSETTS - LOWELL
STUDENT HEALTH INSURANCE PLAN
Annual Dependent Enrollment Form
2025-2026 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.
Dependent Eligibility: Student's spouse or child(ren) under age 26. If a student enrolls a dependent child who reaches age 26 during the policy year, the dependent child will be terminated at the end of the month in which they reach age 26. Domestic Partners are not eligible.
The deadline to complete the Annual 2025-2026 Dependent Enrollment Form is October 10, 2025.
Your student ID# must be entered as an 8-digit number
