Required Health Forms

1. Health Insurance Selection Reporting Form

Important Note for Students Entering in Summer 2014:
If you are beginning classes, taking classes or participating in research during the Summer of 2014 you must complete the Summer Health Insurance Reporting/Selection Form before June 1, 2014 to avoid an unnecessary charge on your account. Please note that the summer form needs to be completed in addition to the fall health insurance/selection reporting form.

For All Entering Students
As you enter Brandeis University this fall, you will need to have qualifying health insurance. The Health Insurance Selection/Reporting form will be made available through SAGE after May 21, 2014. You must complete the form prior to beginning classes and/or research. Failure to do so will result in additional charges on your student account. Should you have any questions, please do not hesitate to contact the Health Center directly.

arrowFull-Time and ¾-Time Students (students enrolled in a full-time program or students enrolled in a program that bills per course and are registered for nine or more credits per semester)
State law requires that all full-time and ¾-time graduate students in the Commonwealth of Massachusetts have health insurance that meets state requirements. Please click here for more detailed information about insurance options from the Health Center's website.

All students must report or select their health insurance by completing the health insurance selection/reporting form and returning it to the Health Center. Failure to report this will result in automatic billing in the QSHIP health insurance plan and the inability to actively utilize your insurance benefits until approximately one month into the semester.

Students must complete the fall Insurance Reporting/Selection form through SAGE prior to the June 30, 2014 deadline to avoid an unnecessary charge to your account. Please note that for students entering in the fall, you cannot report or waive your health insurance until June. Final health insurance will be set at that time.

Ph.D. students who are awarded health insurance as part of their financial package must still sign up for an appropriate health insurance plan or provide a waiver. Failure to do so will result in automatic billing in the QSHIP health insurance plan and the inability to actively utilize your insurance benefits until approximately one month into the semester.

Students may waive coverage of the QSHIP plan providing you have private insurance that is comparable to the QSHIP plan. You will need to provide your private insurance information online through SAGE and submit a photocopy of the front and back of your insurance card to the Health Center. Please log into SAGE to review a detailed list of conditions that would make your private insurance comparable to the QSHIP plan. The Commonwealth of Massachusetts requires that any student who cannot provide proof of a qualifying health insurance plan from a U.S. based company must participate in the insurance program provided by their institution.

All questions should be directed to the Health Center, Brandeis University, 415 South Street, MS 034, Waltham, MA 02453.

arrowPart-Time Students (students enrolled in a program that bills per course and are registered for less than nine credits per semester)

Part-time students are not eligible to enroll in the Brandeis health insurance plans. The Commonwealth of Massachusetts requires that all citizens be enrolled in a state approved health insurance plan.  If you need help selecting a plan, please visit Commonwealth Care.

2. Health and Immunization Record

arrowFull-Time and ¾-Time Students (students enrolled in a full-time program or students enrolled in a program that bills per course and are registered for nine or more credits per semester)
In accordance with Massachusetts state law, all full-time and ¾ time students must submit documentation of all required immunizations before arriving on campus. Please complete the Brandeis Graduate Student Health and Immunization Record.

You must complete pages one and two, which includes your demographic information and medical history. You must also answer the four questions found on the Tuberculosis Screening Questionnaire form.

The Immunization Record (page three) and the TB screening (if applicable) can only be completed by a licensed medical provider. The following are a list of the current mandatory immunizations and are always subject to change:

  • 2 doses of MMR (measles, mumps, rubella) given on or after your first birthday, or proof of immunity by titer in ENGLISH.
  • Tetanus Diphtheria or Tdap within the last 10 years.
  • Hepatitis B series: 3 doses given on schedule or proof of antibody by HBsAb in ENGLISH.
  • Meningococcal within the last 5 years or the signed Meningococcal waiver form.
  • Tuberculin skin test if indicated.
The Health and Immunization Report is due prior to your arrival at Brandeis. If any mandatory vaccines are needed, they will be available at the Brandeis Health Center for a fee. Currently the total cost for all vaccines is $505/USD payable by cash, check or credit card. These costs are always subject to change.

If you are unable to locate your immunization records, check with your local clinic or doctor, parents, your undergraduate institution, or any military records. We can accept copies of your immunization records, provided they are in ENGLISH.

Failure to comply with these requirements will result in a hold being placed on your student account, which will prevent you from registering for courses. If you have any questions, please contact Anna Porter at (781) 736-3677 or by e-mail.

arrowPart-Time Students (students enrolled in a program that bills per course and are registered for less than nine credits per semester)
Part-time students are not required to submit health or immunization reports.