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Please fill out the following form or call us directly at 1-860-471-0347 (TTY: 711).

All fields marked with a RED asterisk (*) are required in order to proceed.

Your Contact Information

*First Name

*Last Name

*Title

*Phone

*Email

*School Name

*Address

*City

*State

*Zip Code

Preferred contact method

Phone

Postal Mail

Miscellaneous Information

*Estimated total number to be insured

Do you have a Student Health Center?

Yes

What products are you interested in?

Medical Plans

Dental Plans

Sports Accident Plans

Student Assistance Program (SAP)

Discount Programs

Would you like an Account Executive to visit?

Yes

What would you like changed in your current plan design?

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Accessibility Services: If you are a person with a disability who needs assistance using our websites, our Customer Service Representatives can assist you. Please call them at the number on your member ID Card or at 877-480-4161 from 8:30 a.m.-5:30 p.m, Mon-Fri. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS).

If you need a PDF document in an accessible format, you can request it directly through"Contact Us" here or at the top of the page.

151 Farmington Avenue, Hartford, CT 06156. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. Massachusetts license number: 10041444. California license number: OB84599.

Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). In MD and NJ, student medical insurance is underwritten by Aetna Health and Life Insurance Company (AHLIC).Self-insured plans are funded by the applicable school, with claims administration services provided by Aetna Life Insurance Company. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company, Aetna Health and Life Insurance Company and their affiliated companies.

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