Imagery of Regent people and campus

Student Insurance Enrollment Form

This form should be completed prior to the application deadline of each semester. You will be prompted to complete the dependents form once this form is submitted. Please use your local address. If you have any questions, please contact the Business Office at 757.352.4059 or

* required field
* First Name:
Middle Initial:
* Last Name:
* Student ID:
* Birth Date: (YYYYMMDD)
* Gender: Male   Female
* Email:
* Phone:
* Local Address:
* City:
* State:
* Zip:
* Country:
Regent University does not intend to sponsor a health insurance plan or require health insurance for students after the 2012-2013 academic year. Usage rates of the plan, changing health insurance regulations, and the administrative workload that is involved in managing the plan were all factors in this decision. Students who enroll in the university-sponsored plan for 2012-13 should expect to have to find their own insurance policy effective August 15, 2013. Regent will not be responsible for students securing health insurance after that date, and will not be responsible for any pre-existing conditions that may impact a student's ability to find alternate coverage. (Please note that international students here on F-1 visas will still be required to have health insurance).
You will be prompted to enroll dependents once this form is submitted.