BRIDGEWATER STATE UNIVERSITY
STUDENT HEALTH PLAN
2017-2018 POLICY YEAR

Spring Termination Request Form

If you were charged for the Student Health Plan (SHP) through the end of the policy year (7/31/18) and are in either of the following situations, you may request to opt out of the SHP for the Spring Semester (1/1/18-7/31/18):

  • You will not be attending BSU during Spring 2018; or
     
  • You have obtained coverage through MassHealth or a subsidized Commonwealth Connector plan that is effective on or before 1/1/18.

If one of these describes your situation and you would like to opt out of the SHP for Spring 2018, please complete this online request form. The submission deadline is 1/31/18.

Asterisk (*) denotes required field

STUDENT INFORMATION
 
first name: *
last name: *
student ID: *