Submit a request – Academic HealthPlans

Please choose your issue below

Your email address

Student Name

First & Last Name

Student ID

Please enter "n/a" if you don't know

I would like to drop coverage for myself and my dependents for the upcoming plan year (2025-26).

I am keeping coverage for myself, drop the dependents below

Coverage to be dropped

Dependents to be dropped

Will need the name/relation of the dependent

Describe your question in a few words:

Please add any additional information or questions (or enter "n/a" if no additional comments)

Attachments

Add file or drop files here