Plan Year Specific Forms
2024 - 2025 DSGHP Forms
- 24 - 25 Midyear Enrollment
- To enroll into the DSGHP after September 1st, due to a loss of other coverage, or during the terms you are enrolled into a study abroad program.
- 24 - 25 Midyear Cancellation
- To cancel the DSGHP coverage for a student or dependent(s) onone of the two midyear cancellation dates.
- 24 - 25 Dependent Application
- To enroll qualifying dependents.
- 24 - 25 Waiver Rescindment
- To rescind an approved waiver.
2023 - 2024 DSGHP Forms
- 23 - 24 Midyear Enrollment
- To enroll into the DSGHP after September 1st, due to a loss of other coverage, or during the terms you are enrolled into a study abroad program.
- 23 - 24 Dependent Application
- To enroll qualifying dependents.