BRIDGEWATER STATE UNIVERSITY
STUDENT HEALTH PLAN
2014-2015 POLICY YEAR

Spring Plan Enrollment Form

In order to ensure that all full time and three quarter time college students have adequate medical insurance while pursuing their academic goals, state law requires that students have coverage, either through the Bridgewater State University Student Health Plan or another United States-based carrier offering comparable coverage.

To waive the University's Student Health Plan, you may provide proof of your comparable coverage by completing a Waiver Form (see link under the menu to the left).

To confirm your enrollment in the University's Student Health Plan, you may continue using this form. Enrollment information for students who complete an online Enrollment Form and have paid for the insurance (or have made arrangements for financial aid to cover the charge) may be sent to University Health Plans/BCBS earlier than the waiver deadline. To confirm payment, please contact Student Accounts via email at SAO@bridgew.edu or via phone at (508) 531-1225. Failure to confirm payment with Student Accounts may delay your enrollment in the school sponsored plan.

If you are eligible for the Student Health Plan and do not complete a Waiver or Enrollment Form, your enrollment request will not be submitted to University Health Plans/BCBS. Payment must be confirmed for anyone who does not complete an online waiver/enrollment form. Failure to complete an online enrollment form and/or failure to confirm payment with Student Accounts may delay your enrollment in the school sponsored plan.


To continue the enrollment process, you will need your Banner ID number which can be found on your tuition bill. This ID number is not your social security number nor your Connect Card number. Please enter your Banner ID below.

By continuing the enrollment process, you are confirming that: (1) you want to be enrolled in the Student Health Plan provided by Bridgewater State University; (2) you understand that you will be held responsible for the insurance premium of $1,088 that has been charged to your student account; and (3) you understand that you must confirm payment with Student Accounts.

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