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

2020-2021 Policy Year Enrollment Form
(August 15, 2020 - August 14, 2021)


St. John’s University has decided to offer coverage with a new carrier, Empire BlueCross BlueShield, for the 2020-2021 policy year. Please make sure to review the benefit information (available soon) and utilize the provider search tool in the menu of the left-hand side of this page.

This form is for Non-Resident students only.  If you are a registered student living off campus for fall semster and do not elect to enroll by the fall deadline you will not be eligible to enroll for the 2020-2021 policy year. 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 within 60 days 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)