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Yeshiva University and Cardoza School of Law

Qualifying Life Event Enrollment Form
2023-2024 Academic Year

If you have a life event outlined below, you may qualify for special enrollment rights to enroll in the student insurance plan outside the initial enrollment period. 
Loss of Other Coverage:
  • Required Documentation: loss of coverage letter that includes the student and/or dependent's name and last day of coverage. Loss of coverage can also include the loss of network access. If your prior plan previously included NYC in the plan's network, documentation of the date the plan no longer includes NYC can be provided and considered a loss of other coverage. 
  • Deadline: 31 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 Household
  • Required Documentation: marriage certificate, birth certificate, passport stamp entering US. 
  • Deadline: 31 days from date of marriage, birth or entry into the US
  • Effective Date of Coverage: date of marriage to the student, date of dependent's birth, or date dependent moves to the US

Asterisk (*) denotes required field