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Rider University

Qualifying Life Event Enrollment Form
2023-2024 Academic Year

qualifying life event is a change in your situation that makes you eligible to enroll in the student health insurance plan outside of your initial open enrollment period. Students eligible for the Rider SHIP can use this form to enroll in one of the situations described below. Eligibility will be verified before enrollment is processed. 

Loss of Other Coverage:
  • Required Documentation: loss of coverage letter that includes the student's name and last day of coverage
  • Deadline: 60 days from the last day of coverage in the prior plan
  • Effective Date of Coverage: the first day without coverage in the prior plan
Change in Plan's Coverage Area:
  • Required Documentation: letter from prior insurance company confirming the date the plan no longer includes New Jersey in the plan's coverage area
  • Deadline: 60 days from the date the plan no longer covers New Jersey
  • Effective Date of Coverage: the first day without coverage in the prior plan

Asterisk (*) denotes required field