Individual Student Opt IN Form 2020-2021
This form is to be used ONLY when a student does not normally qualify for benefits.
NOT AVAILABLE FOR SPRING/SUMMER TERM!
STUDENT INFORMATION *mmandatory
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Individual Student Opt IN Form 2022-2023
STUDENT INFORMATION *mandatory
After reviewing the flex plan options found on www.wespeakstudent.com, please indicate below which Flex Plan Option you would like to enroll in.
Please indicate one of the following options:
Balanced, Enhanced Drug/Vision, Enhanced Dental/ Vision, Enhanced EHC/Vision.
This form is to be used ONLY when a student does not normally qualify for benefits. If you are a full-time fee paying student, you do NOT complete this form. By clicking 'Proceed to Checkout' you are agreeing that the above information is accurate, and true.
If you are not currently enrolled in the health plan, but would like to be, you can use the form below to opt in.