UMASS-BOSTON
STUDENT HEALTH INSURANCE PLAN
2025-2026 POLICY PERIOD
DEPENDENT COVERAGE ENROLLMENT FORM
All full-time and three-quarter time graduate and undergraduate students who are enrolled in the Student Health Insurance Plan (SHIP) may choose to enroll their dependents by submitting this dependent enrollment form.The deadline to submit the dependent enrollment form for the 2025-2026 policy year is October 1, 2025. Payment for the dependent insurance charge must be paid at time of enrollment.
Dependent coverage, if elected, begins and ends with the student’s coverage and must be purchased at the same time the student enrolls in the plan. Eligibility will be confirmed. Dependents will not be enrolled until the student has been enrolled.
PLEASE NOTE: In order to remain insured for both fall and spring semesters, students must be registered for both semesters and must maintain the required number of credits. Students who are not registered for spring or are not registered for enough credits for spring semester will be removed from the SHIP as of January 1, 2026.
If you have a dependent(s) enrolled in the plan, your dependent will no longer be eligible for coverage in the spring if you are not a registered student in the spring semester. Dependent coverage will terminate if student coverage is terminated.
Dependent Eligibility: Student's spouse or child(ren) under age 26. If a student enrolls a dependent child who reaches age 26 during the policy year, the dependent child will be terminated at the end of the month in which they reach age 26.
Coverage may be purchased for your eligible dependents after the initial enrollment period deadlines passes only if one of the following qualifying events has occurred during the Policy Year: 1) birth of a child; 2) adoption of a child; 3) marriage; 4) spouse’s/child’s loss of other creditable coverage; or 5) spouse’s/child’s entry into the United States. You must make the request by submitting a “Qualifying Event Enrollment Form” to University Health Plans, with supporting documentation showing that the qualifying event occurred within the last 60 days.
TO CONTINUE THE DEPENDENT ENROLLMENT PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:
