2021 - 2022 DSGHP FORMS
21 - 22 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.
21 - 22 Midyear Cancellation
- To cancel the DSGHP coverage for student or dependent(s) on one of the two midyear cancellation dates.
21 - 22 Dependent Application
- To enroll qualifying dependents.
21 - 22 Waiver Rescindment
- To rescind an approved waiver.
21 - 22 DSGHP Medical Claim Form
21 - 22 DSGHP Prescription Claim Form
21 - 22 DSGHP Tax Forms & When Coverage Ends Information
- 1099HC (Massachusetts residents only)
- 1095-B (All DSGHP enrollees)
- Extending DSGHP coverage after leaving the college
- HIPAA letter (Proof of coverage terminating, typically needed for enrollment in other health/insurance plans)