Insurance - Forms



SUMMER 1--May 1, 2018 to May 18, 2018

SUMMER 1--June 1, 2018 to June 28, 2018


ALL Students Must Waive or Enroll Annually.  If you waived for Fall or Spring, you do not need to waive again for Summer.  You will need to waive or enroll for Fall, 2018.

Instructions for Using the SHIP Online Enrollment/Waiver Process:    

You must be registered and have an active Mines email to waive or enroll
Login to Trailhead and click on the Self Service button.  Click on the Student link.
Click on the Registration link.
Near the bottom of the list, right click on "Enroll/Waive in Student Health Insurance Plan (SHIP)" and choose "Open in New Tab/Window."
The page that displays is UHCSR’s Enrollment/Waiver page.  Follow the instructions on the page to complete your enrollment/waiver. (It is recommended that you use a desktop browser such as internet explorer, safari, Chrome, or firefox as a mobile device may not work correctly. If you encounter problems, try using internet explorer, as it seems to be the preferred browser.)

If you are ENROLLING:

The sooner you enroll the better! This will get your information into all systems so that your coverage will be fully active on the plan start date in January 9, 2018.
If you choose to default enroll, it may be early February before you are fully activated in the system, which could result in delay of claims processing and prescription coverage.

If you are WAIVING:

Please be sure you fill in ALL blanks, especially the name of the employer providing coverage.  Many group plans through an employer will meet our waiver requirements, while most privately purchased plans do not.  If you do not fill in the employer, it will cause your waiver to be delayed, and may be denied as it will be assumed it is a privately purchased plan.
Upload a copy of your insurance card (front and back) at the UHCSR site.
If you purchase your plan through the Colorado Health Insurance Exchange, it will meet all requirements to waive.
Be honest when filling out the waiver.  Falsifying information in order to get the waiver accepted is a violation of CSM's Honor Code.  If discovered, you will be automatically enrolled as an "unqualified late enrollee" which could result in monetary penalties and violating the honor code could result in academic penalties.
The waiver credit will be on your account by Census Day, January 24.
 PRINT OUT THE CONFIRMATION PAGE AS WELL AS THE CONFIRMATION EMAIL . This is your proof of having submitted a waiver in the event of a problem.

Rates for the 2017-18 Academic Year

Annual  $1990 (billed $995 Fall and $995 Spring Semester--coverage 8/18/17 to 8/19/18)

Spring/Summer 2018 $1215 (coverage 1/9/18 to 8/19/18)

Summer 1, 2018 $534 (coverage 5/14/18 to 8/19/18)

Summer 2, 2018  $305 (coverage 6/25/18 to 8/19/18)

Please note: Dependent coverage is not available through the Student Health Insurance Plan.

Summary of Benefits for the SHIP 2017-18PDF versionText only version

Summary Brochure and Cost for the SHIP 2017-18PDF versionText only version

Online Waiver/Enrollment Instructions