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American International 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 American International College before enrollment is processed. Online-only students are not eligible for the plan.

Loss of Other Coverage:

  • 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:

  • Required Documentation: If you were insured by a private insurance plan that no longer provides comprehensive benefits in MA, documentation is required to confirm the date the plan no longer provides comprehensive benefits in MA.  
  • Effective Date of Coverage: the date you lost coverage in MA via your private insurance plan. 

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

Asterisk (*) denotes required field