2021-2022 Plan Year Information
Coverage Dates
Health Plan Coverage Dates
| Term | Dates |
| Fall | 08/23/2021 - 01/17/2022 |
| Spring (includes Summer term) | 01/18/2022 – 8/21/2022 |
| Summer | 05/16/2022– 8/21/2022 |
Dental Plan Coverage Dates
| Term | Dates |
| Fall | 09/01/2021 - 01/31/2022 |
| Spring (includes summer term) | 02/01/2022– 08/31/2022 |
Coverage Costs
Coverage Costs for Students
Fall and Spring Semester
| Coverage for | Cost |
| Student | $1,398/semester |
| Spouse | add $2,039/semester |
| One child | add $1,575/semester |
| Two or more children | add $2,415/semester |
Summer Term
| Coverage for | Cost |
| Student | $690/semester |
| Spouse | add $1,039/semester |
| One child | add $803/semester |
| Two or more children | add $1,231/semester |
Costs for International Scholars
| Coverage for | Cost per month |
| Scholar | $274 |
| Spouse | add $340 |
| One child | add $263 |
| Two or more children | add $403 |
| Family | $1,017 |
Brochures and Documents
Student Health Benefit Plan
Student Dental Plans
- Student Dental Plans Enrollment Brochure
- Preventive and Periodontal Plan Summary of Benefits (included in SHBP for primary members)
- Optional Dental Buy-Up Plan Summary of Benefits
- Pediatric Dental Plan Summary of Benefits
- Preventive and Periodontal Dental Plan Full Benefits Summary (included in SHBP for primary members)
- Optional Dental Buy-Up Plan Full Benefits Summary
- Pediatric Dental Plan Full Benefits Summary
Forms
Student Health Benefit Plan
- January Enroll and Change Form 2022
- Enroll and Change Form 2021-2022
- Student Information Release 2021-2022
- Learning Abroad Waiver 2021-2022
- Short-term Coverage Extension Enrollment Form 2021-2022
International Students
- International Student Enroll and Change Form 2021-2022
- International Student Waiver 2021-2022
- OPT International Student Enroll and Change Form 2021-2022
- OPT International Student Dental Enrollment Form 2021-2022
International Scholars
- International Scholar Enroll and Change Form 2021-2022
- International Scholar Payment Form 2021-2022
- International Scholar Waiver Form 2021-2022
- International Scholar Department Authorization 2021-2022
Student Dental Plans
Benefit Summaries
Crookston
2020-2021 Plan Year Information
Coverage Dates
Health Plan Coverage Dates
| Term | Dates |
| Fall | 08/24/2020 – 01/18/2021 |
| Spring (includes Summer term) | 01/19/2021 – 8/22/2021 |
| Summer | 05/17/2021– 8/22/2021 |
Dental Plan Coverage Dates
| Term | Dates |
| Fall | 09/01/2020– 1/31/2021 |
| Spring (includes summer term) | 02/01/2021– 08/31/2021 |
Coverage Costs
Coverage Costs for Students
Fall and Spring Semester
| Coverage for | Cost |
| Student | $1,272/semester |
| Spouse | add $1,878/semester |
| One child | add $1,434/semester |
| Two or more children | add $2,100/semester |
Summer Term
| Coverage for | Cost |
| Student | $648/semester |
| Spouse | add $957/semester |
| One child | add $731/semester |
| Two or more children | add $1,070/semester |
Costs for International Scholars
| Coverage for | Cost per month |
| Scholar | $252 |
| Spouse | add $313 |
| One child | add $239 |
| Two or more children | add $350 |
| Family | $915 |
Brochures and Documents
Student Health Benefit Plan
Student Dental Plans
- Student Dental Plans Enrollment Brochure
- Preventive and Periodontal Plan Summary of Benefits (included in SHBP for primary members)
- Optional Dental Buy-Up Plan Summary of Benefits
- Pediatric Dental Plan Summary of Benefits
- Preventive and Periodontal Dental Plan Full Benefits Summary (included in SHBP for primary members)
- Optional Dental Buy-Up Plan Full Benefits Summary
- Pediatric Dental Plan Full Benefits Summary
Forms
Student Health Benefit Plan
- January Enroll and Change Form 2021
- Enroll and Change Form 2020-2021
- Student Information Release 2020-2021
- Learning Abroad Waiver 2020-2021
- Short-term Coverage Extension Enrollment Form 2020-2021
International Students
- International Student Enroll and Change Form 2020-2021
- International Student Waiver 2020-2021
- OPT International Student Enroll and Change Form 2020-2021
- OPT International Student Dental Enrollment Form 2020-2021
International Scholars
- International Scholar Enroll and Change Form 2020-2021
- International Scholar Payment Form 2020-2021
- International Scholar Waiver Form 2020-2021
- International Scholar Department Authorization 2020-2021
Student Dental Plans
