University of Massachusetts - Boston
Student Health Insurance Plan
2024-2025 Policy Year Enrollment Form

All full-time and three-quarter time graduate and undergraduate students are required to have comprehensive health insurance coverage in the area of the University. Students who have not filled out a waiver request by the posted deadline will be automatically enrolled in the Student Health Insurance Plan and be responsible for the insurance charge as assessed.

IMPORTANT: DO NOT COMPLETE THIS FORM IF YOU NEED TO WAIVE THE INSURANCE. COMPLETING THIS FORM WILL ENROLL YOU FOR THE PLAN. YOU WILL BE RESPONSIBLE FOR THE PREMIUM CHARGE ON YOUR STUDENT BILL.

Important Notes:

• If you submit this enrollment form you will be enrolled for the coverage period.
• Completion of the online enrollment form you confirm your enrollment in the plan and understand your tuition bill has been charged the fall semester insurance fee. You will be responsible for the insurance charge.
• If you need to enroll dependent(s) in the plan, you must complete the dependent enrollment form by the enrollment deadline posted on the form located on the left-hand side of the page.

The deadline for confirming enrollment in the SHIP for spring semester is March 1, 2025.

PLEASE FILL OUT THE REQUIRED FIELDS BELOW TO CONTINUE THE ENROLLMENT PROCESS: