Coverage Dates
Health Plan Coverage Dates
| Term | Dates |
|---|---|
| Fall | 08/22/2022 - 01/16/2023 |
| Spring (includes Summer term) | 01/17/2023 - 08/20/2023 |
| Summer | 05/15/2023 - 08/20/2023 |
Dental Plan Coverage Dates
| Term | Dates |
|---|---|
| Fall | 09/01/2022 - 01/31/2023 |
| Spring (includes summer term) | 02/01/2023 - 08/31/2023 |
Coverage Costs
Coverage Costs for Students
Fall and Spring Semesters
| Coverage for | Cost |
|---|---|
| Student | $1,734/semester |
| Spouse | add $2,379/semester |
| One child | add $1,830/semester |
| Two or more children | add $2,751/semester |
Summer Term
| Coverage for | Cost |
|---|---|
| Student | $884/semester |
| Spouse | add $1,212/semester |
| One child | add $933/semester |
| Two or more children | add $1,402/semester |
Costs for International Scholars
| Coverage for | Cost per month |
|---|---|
| Scholar | $305 |
| Spouse | add $397 |
| One child | add $305 |
| Two or more children | add $459 |
| Family | $1,161 |
Brochures and Documents
Student Health Benefit Plan
Student Dental Plans
- Student Dental Plans Enrollment Brochure (pdf)
- Preventive and Periodontal Plan Summary of Benefits (pdf) (included in SHBP for primary members)
- Optional Dental Buy-Up Plan Summary of Benefits (pdf)
- Pediatric Dental Plan Summary of Benefits (pdf)
- Preventive and Periodontal Dental Plan Full Benefits Summary (pdf) (included in SHBP for primary members)
- Optional Dental Buy-Up Plan Full Benefits Summary (pdf)
- Pediatric Dental Plan Full Benefits Summary (pdf)
Forms
Student Health Benefit Plan
- Enroll and Change Form 2021-2022 (pdf)
- Student Information Release 2021-2022 (pdf)
- Learning Abroad Waiver 2021-2022 (pdf)
- Short-term Coverage Extension Enrollment Form 2021-2022 (pdf)
International Students
- International Student Enroll and Change Form 2021-2022 (pdf)
- International Student Waiver 2021-2022 (pdf)
- OPT International Student Enroll and Change Form 2021-2022 (pdf)
- OPT International Student Dental Enrollment Form 2021-2022 (pdf)
International Scholars
- International Scholar Enroll and Change Form 2021-2022 (pdf)
- International Scholar Payment Form 2021-2022 (pdf)
- International Scholar Waiver Form 2021-2022 (pdf)
- International Scholar Department Authorization 2021-2022 (pdf)
Student Dental Plans
Benefit Summaries
Crookston
- Summary Plan Description Crookston (pdf)
- Summary of Benefits Coverage Student Only Crookston (pdf)
- Summary of Benefits Coverage Student and Family Crookston (pdf)
Duluth
- Summary Plan Description Duluth (pdf)
- Summary of Benefits Coverage Student Only Duluth (pdf)
- Summary of Benefits Coverage Student and Family Duluth (pdf)
Morris
- Summary Plan Description Morris (pdf)
- Summary of Benefits Coverage Student Only Morris (pdf)
- Summary of Benefits Coverage Student and Family Morris (pdf)
Rochester
- Summary Plan Description Rochester (pdf)
- Summary of Benefits Coverage Student Only Rochester (pdf)
- Summary of Benefits Coverage Student and Family Rochester (pdf)