Lehigh University
Student Health Insurance Plan

STUDENT ENROLLMENT FORM
2018-2019 POLICY YEAR

The following students are eligible to enroll and are required by Lehigh University to have Health Insurance. Therefore the following students are automatically enrolled in this Insurance Plan:
• Undergraduate matriculating students registered for five (5) or more credits
• Undergraduate non-matriculating students (non-degree/General College Division) registered for twelve (12) or more credits
• Graduate students enrolled in a degree seeking on-campus based program and registered for nine (9) or more credits.
• Graduate students registered for dissertation credits
• All Lehigh international students on an F-1 or J-1 visa regardless of number of registered credits

The charge for the annual premium will be included on the student’s fall invoice once the student meets the minimum registration eligibility requirements.

Those students who are insured under another policy may drop his/her coverage under this Insurance Plan and have the premium credited back to his/her university account by completing a waiver form by the July 1st deadline or within 10 days of becoming eligible if the minimum registration requirements are met after July 1st.

Courses offered through a Distance Education program do not fulfill the Eligibility requirements.

Submitting the online enrollment form may expedite the processing of your enrollment in the Student Health Insurance Plan. If you do not complete a waiver or enrollment form by the deadline, your enrollment information will not be submitted to University Health Plans until after the deadline has passed.

  • Confirmed enrollments that occurr after July 31st may be subject to a late processing fee of $25.
     

To continue the enrollment process, please fill out the required fields below:

***STEP 1 OF 4***

date of birth: (MM/DD/YYYY)
LIN (Lehigh Identification Number):