Create an Account | Your Student Health Plan

Create Your Account

Please use the form below to create an account to proceed with enrolling in the BCBSM Student Health Plan.

ENROLLMENT REQUEST FORM

"*" indicates required fields

Name*

First Last

Date of Birth*

Sex Assigned at Birth:*

Male

Female

Student ID*

Email Address. University issued email address is preferred.*

Phone

This field is for validation purposes and should be left unchanged.