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Rhode Island School of Design
STUDENT HEALTH INSURANCE PLAN

Dependent Annual 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. 

 


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

Asterisk (*) denotes required field

 (MM/DD/YYYY)