MCPHS University
Student Health Insurance Plan

QUALIFYING EVENT ENROLLMENT FORM

A qualifying event is an event is an involuntary loss of a comparable health insurance plan. The loss of coverage may make you eligible for a special enrollment period, allowing you to enroll in the student health insurance outside the open enrollment period. If you have lost your other comparable insurance plan within the last 60 days, you may follow the below steps to enroll in the MCPHS Student Health Plan or contact University Health Plans at 833-251-1707 to discuss your eligibility. *This enrollment form is for students ONLY, to enroll a dependent please contact University Health Plans for instructions. 

All qualifying events require documentation to provide proof of your qualifying event and proof of payment of the prorated premium to MCPHS Student Accounts. If you have questions about the documentation required or prorated premium amount to pay to MCPHS Student Accounts, please contact University Health Plans at 833-251-1707 BEFORE you submit your enrollment form. 

Important information:

• Effective Date: first day after your previous plan ended, please refer to your documentation to confirm the date in which enrollment will begin. (i.e. if your prior plan ended on 8/31/2023, your first date of coverage should be entered as 9/1/2023)
• Required Documentation: loss of coverage letter that includes student's name and last day of coverage and proof of prorated premium payment to MCPHS Student Accounts
• Enrollment Deadline: 60 days after your previous plan ended

MCPHS Student Account Center, Click to Access Information and to Make a One-Time Payment : You will need to complete payment for your prorated enrollment premium to MCPHS Student Accounts and upload documentation of payment during this process. Failure to provide documentation of proof of payment will delay processing of your qualifying life event enrollment.

To continue the enrollment process, please fill out the required fields below:

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