Please complete the correct form for your situation and send it to email@example.com along with any additional documents.
Midyear enrollment form
The midyear enrollment form (PDF) is for eligible students who wish to enroll in NUSHP during our open enrollment period. Our open enrollment period is December 1, 2023, to January 31, 2024. During our open enrollment period, you do not need to show proof of a qualifying life event. Coverage will start January 1, 2024.
The deadline to submit the form is January 31, 2024.
Petition to enroll – student
The petition to enroll student form (PDF) is for eligible students who would like to join the student health plan outside of the open enrollment period because they have had a qualifying life event and are in need of insurance. Students will be enrolled on the first day of the month that they request coverage to begin.
Petition to enroll – dependent
The petition to enroll dependent form (PDF) is for enrolled students who would like to add dependents to their student health plan outside of the open enrollment period.