Medical Plan Enrollment

I have carefully read the brochure and elect to enroll as indicated. Rates are not pro-rated other than as listed. I authorize the university to provide Aetna Student Health with my enrollment status to validate eligibility under the Plan. I warrant that the information I have provided in this application is true and accurate. If it is later determined that I have provided inaccurate information, my coverage and the coverage of my dependent(s) may be voided. Please make sure you understand your school’s credit hour and other requirements for enrolling in this plan. Aetna Student Health reserves the right to review, at any time, your eligibility to enroll in this plan. If it is determined that you did not meet the school's eligibility requirements for enrollment, your participation in the plan may be rescinded in accordance with its terms.

Enrollment Guidelines: Please refer to your school insurance plan brochure for your enrollment effective date. Applications will not be accepted after the enrollment deadline.

The college/university plan may not cover all your health care expenses. The plan excludes coverage for certain services and contains limitations on the amounts it will pay. Please read the plan brochure carefully before deciding whether this plan is right for you. Also, while the plan brochure tells you about some of the important features of the plan, other features may be important to you and some further limit what the plan will pay. If you want to look at the full plan description, which is contained in the Master Policy issued to the college/university, you may contact us at 877-437-6512. Many plans contain annual and/or per condition maximums. Some illnesses may cost more to treat than what the plan will pay and health care providers may bill you for what the plan does not cover.