Forms & Resources

student enjoying nice weather on the lakefill

Below you will find Northwestern’s student insurance forms, and downloadable copies of NU-SHIP plan documents, in addition to resources to assist you in educating yourself about insurance coverage, and researching health insurance options for your particular needs.

Student Insurance Forms & Documents

NU-SHIP documents:

Mid-Year Changes / Cancellations

  • 2017-2018 Petiton to Waive Form (pdf) used to terminate NU-SHIP coverage in the middle of the academic year, due to gaining new coverage, i.e., through new employment. You must submit supporting documentation with this form, that shows the start date of your new coverage. This form should be submitted within 30 days of your insurance coverage change.
  • 2017-2018 Petition to Add Form (pdf) – used to enroll in the NU-SHIP in the middle of the academic year, due to losing your existing coverage, i.e., aging off parents' plan at 26. You must submit supporting documentation with this form, that shows the end date of your former coverage. This form should be submitted within 30 days of your insurance coverage change.
  • 2017-2018 NU-SHIP Cancellation Form (pdf) – used to request to terminate NU-SHIP coverage due to graduating from your Northwestern program (only available to students graduating at the end of fall or winter quarters), or due to withdrawing from the University.

Financial Assistance for NU-SHIP

  • 2017-18 Health Insurance Financial Assistance Request form (pdf) – Pell-eligible students are encouraged to apply to Financial Aid for assistance with NU-SHIP premium costs. (Please note: out-of-state Medicaid plans do not provide coverage in Illinois, and consequently, do not meet Northwestern's requirements for comparable coverage. Additionally, students covered under out-of-state HMOs should check if their plans offer in-network, non-emergency coverage in the Chicago / Evanston area.)