Student Health Insurance Enrollment Form - 2020-2021

Description of Student Health Insurance Program

The DMU Sponsored Health Insurance Plan is a Preferred Provider Plan that has been designed specifically for DMU students and is underwritten by Aetna Student Health. With an emphasis on wellness, the plan is designed to provide full coverage for medical care including annual routine physicals and immunizations.

Health Insurance Plan - Aetna Student Health Summary of Benefits and Costs
Policy Plan Year 08/01/2020 - 07/31/2021

The DMU Student Insurance Plan for the 2020/2021 Policy Year  will take effect on 08/01/2020. If you would like to review the 2020/2021 DMU Summary of Benefits please click here.    

All students will be charged for student only coverage in the DMU Sponsored Student Health Insurance Plan at the start of the academic year. The charge to the student's account will be removed if an approved waiver is granted. 

Plan Rates for 2020/2021

Annual

Student Only

$3,200.00

 

First Year PA Students Plan Year 06/01/2020-07/31/2021*

All PA students will be charged for student only coverage in the DMU Sponsored Student Health Insurance Plan at the start of the academic year. The charge to the student's account will be removed if an approved waiver is granted.

Plan Rates for 2020/2021

Annual

First Year PA Students

$3,750.00

*First Year PA students will be enrolled on the 2019-2020 policy from 06/01/2020-07/31/2020.  The annual premium includes the 2020-2021 premium which is still pending state approval and subject to change.

Health Insurance Plan - Aetna Student Health Summary of Benefits and Costs
Policy Plan Year 08/01/2019 - 07/31/2020

All students will be charged for student only coverage in the DMU Sponsored Student Health Insurance Plan at the start of the academic year. The charge to the student's account will be removed if an approved waiver is granted. 

Plan Rates for 2019-2020

Annual

Student Only

$3,300.00

DMU 19-20 Summary of Benefits

Aetna Student Health Discount Program

In addition to the medicall benefits, those enrolled in the DMU student health plan will have access to an Aetna discount program which will provide savings for dental, vision, fitness clubs and more for an annual membership fee.

If you would like to request enrollment in the DMU Student Health Insurance Plan please click on the Student Verfication link to begint the process.

To begin the enrollment process please enter your demographic information below and click the "next" button at the bottom to continue.

Enrollment is currently open for the 2020-2021 Policy Year. All enrollment dates will be verified for compliance to the DMU Insurance Policy.

Please enter your information. Fields with * are required

Your Student ID is also required. This is the 7 digit number that begins with 0. Continuing students can find this in the My Profile section of My Pulse. Incoming students can find this within your DMU username.

Please add any dependents (Spouse, Domestic Partner, Child):

  • Dependent 1

  • Dependent 2

  • Dependent 3

  • Dependent 4

  • Dependent 5

Add Dependent

Please choose your insurance coverage:

PA Students please enter or select 06/01/2020 for your enrollment date All other students please enter or select 08/01/2020 for your enrollment date. Dependent coverage is not available on the DMU Student Health Insurance Plan.

  • Dependents Also?

If you have any extra documents you would like us to have, please upload them here. Only .doc, .docx and .pdf files are accepted. Up to two documents may be uploaded. Each file may be no larger than 10 Megabytes.

Please Confirm the information you entered, then click submit.

Student Information

Last Name
Middle Initial
1
First Name
Gender
Social Security Number
Student ID
Home Address
Home Address 2
Home City
Home State
Home Country
Home Zip
Phone Number
Personal Email
University Email
Program
Date of Birth

Dependent 1

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Dependent 2

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Dependent 3

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Dependent 4

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Dependent 5

First Name
Last Name
Type
Gender
Date of Birth
Social Security Number

Insurance Information

Medical
Medical For Dependents
Requested Enrollment Date

Documents

Document 1
Document 2

Digital Signature

** By typing your name in the Signature field, you hereby certify that the information entered into this form is true and correct to the best of your knowledge.

  • Comments

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