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 BCN Student Health Plan.

ENROLLMENT REQUEST FORM

Before completing and submitting this form verify you did not already receive an email from Blue Water Benefits containing your User ID and Temporary Password.

"*" 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)*

Academic Level*

While attending school, do you reside in Michigan?*

Yes

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