Postdoc Plan

Download Application Forms for Medical Insurance

Termination request for dependent coverage

  • If you wish to terminate dependent coverage, please complete the form below and send it to Student Blue via email or fax.
  • Termination requests must be received 10 days prior to the first day of the month that coverage is no longer desired.
  • Terminations are available on a monthly basis and effective on the last day of the month.
  • There are no refunds.
Termination Form [pdf]