Insurance Requirement Forms
Online Health Insurance Information Form
Online form is only available until the first day of classes.
After logging in Select the current term and follow the instructions.
Printable Health Insurance Information Form
If prior to the first day of classes, online form must be used.
Fax to 885-1002 or place in the SHIP DROP BOX just inside the University Avenue Entrance of the Student Health Building
Print Proof of Insurance Card--print each semester
Student Health Insurance Program (SHIP) Forms
After logging in Select the current term and follow the instructions. If you were enrolled in SHIP for spring semester it includes summer coverage dates so select the applicable SPRING TERM when submitting your request.
The forms below can be faxed to: (208) 885-1002;
Mailed to: 875 Perimeter Drive MS 4201, Moscow ID 83844-4201;
or dropped off at the SHIP Office, Room 129 in the Student Health Building.
There is a SHIP Office Drop Box inside the University Avenue entrance of the Student Health Services building.
SHIP Qualified Late Enrollee Form
--for students who have involuntarily lost employer sponsored health insurance or Medicaid. Documentation showing details of the qualifying event must be attached to the completed form and submitted within 30 days of loss of coverage.
SHIP Special Circumstance Enrollment Form
--for students who do not meet the standard eligibility provisions for SHIP enrollment. Form must be completed by the first day of each semester.