Massachusetts College of Art and Design
Student Health Insurance Plan
Qualifying Event Enrollment Form
2024-2025 Academic Year
A qualifying life event is a change in situation, such as a loss of other coverage, or moving from your plan’s service area, that makes you eligible for special enrollment rights.
Students with one of the following qualifying life events may use this form to enroll in the Student Health Insurance Plan while continuing to be active eligible students. Eligibility will be verified with MassArt before enrollment is processed. Online-only students are not eligible for the plan.
Loss of Other Coverage: If your other insurance coverage recently ended, you may qualify for special enrollment rights
- Required Documentation: loss of coverage letter that includes your name and your last day of coverage
- Effective Date of Coverage: the first day without coverage in the prior plan
Initial Entry into the U.S.
- Required Documentation: passport showing identification and U.S. entry date
- Effective Date of Coverage: the date of entry into 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 833-251-1710 before you submit your enrollment form.
The deadline to enroll is 60 days from the qualifying life event.
