Rhode Island College
Student Health Insurance Plan

2022-2023 Policy Period
Voluntary Student Enrollment Form

ENROLLMENT DEADLINE: September 22, 2022

This form is for fall students who are not automatically charged but meet eligibility requirements to enroll. Eligibility will be confirmed with the school prior to processing.

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

Important: Please enter your 7-digit RIC Student ID number with the leading zero in the Student ID field below.  If you do not have this number, please contact the Rhode Island College Bursar's Office.

Asterisk (*) denotes required field

STUDENT INFORMATION

 (7 digits including leading zeros)
 (MM/DD/YYYY)