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How to apply for an extension of coverage

How to apply for an extension of coverage

Written notification AND receipt of payment for the extension must occur within 60 days of your plan expiration date. Failure to submit both items before the 61st day will result in a rescission of the extension back to the initial expiration date. Please note that there are no refunds on the extension once the extension term has begun. Please see the SHP certificate of coverage (“Extension of Coverage” information) for details. *For an accommodation for this PDF, please contact studentbenefits@cornell.edu.

Dependent coverage may also be extended for the same period as that of the student, provided SHP coverage was already active for the dependent(s). Simply indicate the type of coverage to be extended on the form as needed.

To provide written notification for an extension:

  1. Log in to Gallagher Student Health with your Cornell NetID and password
  2. In the "Plan Details" tile (right-hand side), locate "Other Forms"
  3. Click "Other Forms" > "Plan Year 2021-2022"
  4. Select "Extension Enrollment Form”
  5. Complete the form
  6. Make the payment for the coverage as indicated on the form

Email the form along with proof of payment to: Quincy.BSD.enrollmentteam@AJG.com

Extensions of coverage are not bursar billable. Payment for the extension is only accepted through our payment page Pay (cardpointe.com) using a debit or credit card as indicated on the extension enrollment form. The extension payment receipt will be sent to the email address entered for the billing information. Please check your spam folder if the payment receipt is not received.

If you are not eligible for an extension, the extension of coverage will not be processed and any payment will be refunded.