Skip to main content

Emerson College

Qualifying Event Enrollment Form
2023-2024 Academic Year

A qualifying life event is a change in situation, such as a loss of other coverage, or moving from your plan’s service area, that makes you eligible for special enrollment rights.

Students with one of the following qualifying life events may use this form to enroll in the Student Health Insurance Plan while continuing to be active eligible students. Eligibility will be verified with Emerson before enrollment is processed. Online-only students are not eligible for the plan.
Loss of Other Coverage: If your other insurance coverage recently ended, you may qualify for special enrollment rights
  • Required Documentation: loss of coverage letter that includes your name and your last day of coverage
  • Effective Date of Coverage: the first day without coverage in the prior plan
Living Away From Plan's Service Area: if you move from your plan's service area or your plan's service area no longer provides comprehensive benefits in the area where you attend school, you may qualify for special enrollment rights.
  • Required Documentation: 
    • If you were insured by a private insurance plan that no longer provides comprehensive benefits in the area you live while attending school, documentation is required from your insurance company to confirm the date your plan no longer provides comprehensive benefits in the school's location. For example, documentation that your plan changes from a PPO to an HMO on 1/1/2024.
    • If you are insured by a plan that provides comprehensive benefits where you attend school (Boston), and you will move from the school's primary location during the academic year, we require documentation from the insurance company confirming it does not provide comprehensive benefits in the location where you will move. You must also provide documentation of the date you are moving. For example, the first documentation should be that you have an HMO or another type of closed network plan (Medicaid). The second documentation should confirm you are moving. If you are attending classes in Los Angeles or Kasteel Well, provide documentation that you are enrolling in the program and choose the start of the spring coverage period, 1/1/2024, as your effective date. 
  • Effective Date of Coverage: the date you lost coverage in MA via your personal insurance plan. Or the date you move to a new location that does not include comprehensive coverage via your personal insurance plan. If you are studying in Los Angeles or Kasteel Well, choose 01/01/2024. 

The deadline to enroll is 60 days from the qualifying life event. 


Asterisk (*) denotes required field