Student Health Plan
	Administered by:
	Benefit Administrators, Inc.

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Online Enrollment / Waiver Form

To begin the Online Enrollment/Waiver from please enter your Student ID number and Birth Date below.

Student ID:
Birth Date:		(mm/dd/yyyy or mmddyyyy)

If you are having trouble logging in please call (814) 453-3633 or enter student name, student id, birthdate, and contact email/phone no. to send an email to the administrator. You will be contacted by the end of the next business day.

Click 'Continue' to proceed to Enrollment / Waiver form   

Notice:Mercyhurst College requires all student Athletes and International Students to have certain minimum health care requirements in order to attend classes for the 2010-2011 Academic Year. The requirements are as follows:

Student Athletes:

- Must cover injuries that occur during participation in intercollegiate athletics
- Has limits of at least $90,000 that includes coverage for sport-related injuries

International Students

- Offers at least 80% coverage for in-patient and out-patient medical services
- Includes Mental Health benefits
- Has a deductible that does not exceed $500
- Does not contain any language limiting coverage on pre-existing conditions
- Lifetime maximum of at least $1,000,000

If you are either an Athlete or International Student, and the coverage you currently have meets or exceeds the above requirements, you must complete a waiver form to opt out of the Mercyhurst College Student Health Plan.

Enrollment for all other students is Voluntary.