Petition to Add Form
Students who initially waived the student insurance plan can petition to add coverage if they experience a qualifying event. Qualifying events include:
- Reaching the age limit of another health insurance plan
- Loss of health insurance through a marriage or divorce
- Involuntary loss of coverage from another health insurance plan
A qualifying event does not include a student who is seeking enrollment to gain access to a benefit that was exhausted under their current private insurance plan. If you have experienced a qualifying event and would like to enroll in your college/ university's student medical plan, complete a Petition to Add Form.
Cornell University Petition to Add Form.pdf
All documents are in .PDF format. In order to read and print the PTA form, you will need to have Adobe Reader downloaded and installed on your computer. You may click on the image below to download Adobe Reader.
Contact us at 844-691-4005 and we can walk you through the application process and help answer your questions.
Renter's Insurance
(Optional)
Protects students against theft, damage and many other causes of loss to personal property.
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Compare your plan's "Summary of Benefits & Coverage" with Student Health Plans (all plans must provide one).
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All students can enroll for great coverage in Ithaca, and outside the Ithaca area.
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Cornell Health is your primary care provider on the Ithaca campus, no matter what insurance you have.
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- Gallagher Student Health & Special Risk
500 Victory Road, Quincy, MA 02171 - Fax
617-479-0860