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Indiana University
Student Academic Appointees, Appointed
Postdoctoral Fellows, & Fellowship Recipients

Dependent Enrollment Form
2025-2026 Academic Year

Eligible Student Academic Appointees (SAA), Appointed Postdoctoral Fellows, and Fellowship Recipients enrolled in the plan may insure their dependents, including their spouse and children under age 26.

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

Asterisk (*) denotes required field

 (MM/DD/YYYY)