Student Health Insurance Enrollment Form

Enrolling in the WVSOM Student Health Insurance Plan

The WVSOM Sponsored Health Insurance Plan is a Preferred Provider Plan (PPO) that has been designed specifically for WVSOM students and is underwritten by Aetna Student Health (ASH). With an emphasis on wellness, the plan is designed to provide full coverage for medical care, including annual routine physicals and immunizations.  The WVSOM student health insurance plan offers both in-network and out-of-network benefits; it is an ACA-compliant Platinum level plan. 

Student Health Insurance Plan Information 2022/2023

To view the 2022-2023 WVSOM Plan Benefits Summary please click here

To maximize your benefits, you may refer to the following link to locate in-network participating professional or facility providers and obtain a copy of your id card at www.AetnaStudentHealth.com.

Enrollment Process

ll students are required to enroll in the WVSOM - Sponsored Student Health Insurance Plan unless a waiver is submitted and approved. Enrollment and the insurance charge can be waived if proof of other health insurance is provided by submitting an online waiver.

  • To expedite enrollment in the WVSOM Sponsored Student Health Plan, follow the Next - Student Verification tab at the bottom of the page. If you are having difficulties, please contact HSAC at 888-978-8355 or wvsom@hsac.com for assistance.
  • Enrollment in the WVSOM student health plan is automatic unless a waiver request is submitted.
  • If you waived enrollment for the 2021-2022 academic year and wish to enroll in the WVSOM student health plan for the 2022-2023 academic year, follow the "Enroll" tab at the top of the page to request enrollment.
  • Students who lose coverage midterm are required to submit an enrollment request within 30 days of the date of loss of prior coverage for enrollment in the WVSOM-sponsored Student Health Insurance Plan and submit proof of loss of prior coverage to HSAC.

All students will be charged for student-only coverage in the WVSOM Student Health Insurance Plan prior to the start of each semester. The charge to the student's account will be removed if an approved waiver is granted.

Student Health Insurance Plan Premiums 2022/2023 - effective 07/01/2022 - 06/30/2023

Plan Rates 2022-2023                                              

Fall                                               

Spring/Summer                   

Annual *                                                     

Student Only

$ 2,262.00

$ 2,262.00

$ 4,524.00

Spouse Only

$ 2,262.00

$ 2,262.00

$ 4,524.00

Child

$ 2,262.00

$ 2,262.00

$ 4,524.00

*Rates represent Medical only coverage for the full policy year. The premium charge for incoming students is prorated based on the date of enrollment.

Incoming Students for the 2022/2023 Policy Year - Coverage will begin 07/25/2022 - 06/30/2023 and Premium will be billed as follows:

Plan Rates 2022-2023                                              

Fall                                               

Spring/Summer                   

Annual *                                                     

Student Only

$ 1,966.00

$ 2,262.00

$ 4,228.00

Spouse Only

$ 1,966.00

$ 2,262.00

$ 4,228.00

Child

$ 1,966.00

$ 2,262.00

$ 4,228.00

 

Dependent Eligibility

  • Students enrolling for coverage in the WVSOM - Sponsored Student Health Insurance Plan may also enroll their eligible dependents. An eligible dependent is a spouse (or domestic partner) and/or any child(ren) under 26. Students must also enroll their dependents for coverage within 30 days of their initial eligibility.
  • If a student's dependents have coverage that ends during the academic year, the dependents may be enrolled in the WVSOM - Sponsored Student Health Insurance Plan provided the enrollment request is submitted within 30 days of the date of loss of prior coverage.
  • Additionally, if a student acquires dependents during the academic year due to marriage, birth, adoption, or placement for adoption, they may enroll their new dependents provided the enrollment request is made within 30 days after the marriage, birth, adoption, or placement for adoption.

OBTAINING YOUR STUDENT HEALTH INSURANCE PLAN MATERIALS

If you enrolled in the student health insurance plan, you can access your insurance plan ID card, search for providers, view claims information, and review benefits via the Aetna Student Health website.

Next > Student Verification

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

Next > Student Information

Please enter your information. Fields with * are required

Next > Add Dependents

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

  • Dependent 1

  • Dependent 2

  • Dependent 3

  • Dependent 4

  • Dependent 5

Add Dependent
Next > Insurance Details Student Information < Back

Please choose your insurance coverage:

  • Dependents Also?
Edit Dependents < Back Next > Additional Documents Edit Dependents < Back

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.

Next > Enroll Confirmation Insurance Details < Back

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

Next > Sign & Submit Enrollment Additional Documents < Back
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