St. John's University
Student Health Insurance Plan
Qualifying Life Event Enrollment Form
A 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 can use this form to enroll in one of the situations described below.
Loss of Other Coverage (losing health coverage through employer, parent's plan, or Medicaid):
- Required Documentation: loss of coverage letter that includes the student's name and last day of coverage
- Deadline: 30 days from the last day of coverage in the prior plan
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Effective Date of Coverage: the first day without coverage in the prior plan
Change in Residence (entry into the US or moving out of existing coverage area):
- Required Documentation: passport showing identification and stamp of U.S. entry date
- Deadline: 30 days from the date of entry to the U.S.
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Effective Date of Coverage: the date of entry to the U.S.
All qualifying events require documentation to provide proof of your qualifying event. If you have questions about the documentation required, please contact University Health Plans at 1-833-251-1134 before you submit your enrollment form.
Enrollment Deadline: The qualifying event enrollment form, payment, and required documentation must be received within 30 days from the qualifying event date.
If your qualifying event occured before 8/15/2024, please email caitlin@univhealthplans.com for eligibility and enrollment instructions.
In order to successfully complete the below waiver form you will need to provide your Student ID number beginning with the letter "X". Please do not use the number that starts with "9". This will result in the waiver not posting to your student account. If you do not have the student ID number that begins with "X", please contact St. John's University Customer Service at 718-990-2000.
