St. John’s University
Student Health Insurance Plan
Non-Resident Undergraduate Student

Spring 2020 Policy Period Enrollment Form
(January 1, 2020 - August 14, 2020)


This form is for NEW SPRING non-resident students only. If you were a registered student for fall 2019 you are not eligible to enroll at this time. If you are a newly registered spring student living off campus for spring semster and do not elect to enroll by the spring deadline you will not be eligible to enroll for spring 2020. If you do not enroll by the deadline and experience a qualifying life event (ie. loss of other coverage) please contact University Health Plans at 1-800-437-6448 or info@univhealthplans.com as soon as possible to discuss your eligibility.

In order to successfully complete the below enrollment form you will need to provide your Student ID number beginning with "X". If you do not have this number, please contact St. John's University Customer Service at 718-990-2000.

Asterisk (*) denotes required field

STUDENT INFORMATION

 
 (MM/DD/YYYY)