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Forms

The following files are in PDF format. A free PDF reader, Adobe Acrobat, is available for download.

  • BCBS Claim Form
  • BCBS International Claim Form
  • Petition to Enroll in NUSHP Form
  • NUSHP Late Waiver Request Form
  • NUSHP Waiver form(study abroad and co-op students)
  • NUSHP MidYear Enrollment Form
  • UHCS Access Request Form
  • Mid Year Adjustment Form

Email: NUSHP@neu.edu
Address:
Student Health Plan Manager
Northeastern University
135 Forsyth Building
360 Huntington Avenue
Boston, MA 02115
Phone: 617-373-8007
Fax: 617-373-7340

NUSHP

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