Health Insurance Form Umass Lowell

Health insurance waiver see student self service in sis log into your sis account and select waive enroll health insurance form required for those students who are enrolled in at least 9 semester hours or more in a given semester.

Health insurance form umass lowell. Health insurance gic enrollment and change form university of massachusetts office of the president skip to main content. This is an excellent option for students who need insurance. Umass lowell email address must be active. Please call uhp at 800 437 6448 if you have any questions about the enrollment and waiver process or if there are customer service issues with bcbs.

State employee health insurance and benefits rates use the form below to add your dependent ages 19 26 during the gic s annual enrollment when your dependent changes to a full time student living outside of the plan s service area or is no longer a full time student. You may waive coverage if you have this coverage under a comparable benefit plan. Health plan enrollment form pdf complete this form if you want to purchase health insurance coverage for your spouse same sex domestic partner and or dependent children 19 or under. Insurance information form pdf complete this form so uhs can bill your insurance company for your care.

Academic integrity form pdf format the pdf files on this page require the free adobe acrobat reader. Locked account student should log onto portal using umass lowell email address and click on forgot password and follow instructions to reset account. Specific benefits questions you have about receiving your insurance card should be directed to blue cross blue shield of massachusetts member services at 888 753 6615. Questions about the health insurance charge or health insurance waiver should be directed to the solution center by phone.

Gic enrollment and change form must be completely verified within first 10 days of employment. Umass lowell is pleased to announce that for the 2020 2021 academic year we have teamed up with blue cross and blue shield of massachusetts bcbsma to provide health insurance coverage for our students. Access the waive enroll health insurance form. Details about the student health insurance plan shp can be found by selecting benefit information on the left hand side of this page.

Massachusetts requires full time college students to have primary health care insurance.