Health Records and Insurance

Confidential Health Record

All incoming first year students and incoming transfer students are required to complete the Confidential Health Record (CHR) below. The physical must be current (within one year of starting at Ursinus) and signed by a healthcare provider. The Confidential Health Record and Vaccine Exemption Form(if applicable) are due to the Wellness Center by January 15th, 2022. Please print and mail to Ursinus College Wellness Center 601 East Main Street Collegeville, PA 19426.


Immunization and Exemption Policy

Below is the complete list of vaccines that are Mandatory for Admission recommended by The American College Health Association. If you have not had these immunizations and would like to complete a request for exemption from immunization, please review the policy and process above. 

  • Tetanus/Diphtheria (dT) or Tetanus-Diphtheria-Pertussis (DPT)
  • Hepatitis B
  • MMR (Measles, Mumps, Rubella)
  • Polio
  • Varicella (Chicken Pox)
  • PPD
  • Meningitis
  • Covid-19

We strongly recommend immunization for HPV and influenza.

Health Insurance Enrollment/Waiver Process

All new first-year or transfer Ursinus students registered for 12 or more credit hours are required to provide proof of health insurance OR purchase the student health plan option underwritten by United Healthcare. Incoming students for the Spring 2022 term: Please complete the online health insurance waiver/enrollment form (linked below) by January 15th, 2022 at 4:00pm EDT. Students will be automatically billed for the student health plan if the form is not submitted by that date and time. Your student account will be credited if proof of insurance is provided before September 10th, 2021. After September 10th, 2021, students will be automatically enrolled in the student health plan and credit will not be applied to student accounts. 

Click the Insurance Enrollment/Waiver Form link in red letters below to either WAIVE the student health plan or ENROLL in the student health plan. You will need your UC username and password to log in to the form. Make sure you are not logged into your student portal. Do not use Microsoft Edge as your internet browser. Please use Internet Explorer, Firefox or Chrome for best results in accessing the form. Make sure dates are in the correct format. If you still have technical difficulties, call tech support at 610-409-3789. 

Insurance Enrollment/ Waiver Form   

Student Health Plan Information

The annual cost for the student health plan through United Healthcare for the 2021-2022 academic year is $1780.00. The annual coverage is in effect from August 7, 2021 through August 6, 2022.  Any student entering as a full-time student in the Spring 2022 term can purchase the student health plan for Spring 2022 semester and Summer 2022 at a cost of $1068.00, coverage effective January 1, 2022- August 6, 2022. 

New full-time students entering in the Spring 2022 term must complete the health insurance waiver/enrollment online form above. Proof of insurance must be provided no later than January 31, 2022 or a charge of $1068.00 for the student health plan will be applied to your student account.

For more information on the Student Health Plan Option provided by United Healthcare please see the flyer below:

If you have additional questions about what the student health plan covers, please contact First Risk Advisors Customer Service at 800-505-4160. You may also email  or visit for more information.

Losing Your Health Coverage?

If you did not enroll during our open enrollment period and have since lost coverage under your original plan, you may qualify for a Qualifying Life Event. A qualifying life event is an event that triggers an open enrollment window for an individual to purchase the Student Health Plan outside of the scheduled open enrollment period upon providing proof of involuntary loss of coverage and payment, within 30 days of losing coverage. (example: marriage, divorce, loss of job, etc)

The enrollment form, check or money order and the letter of creditable coverage, must be received within 30 days of losing coverage. After 30 days, the student or dependents will no longer be eligible to enroll in the plan, until fall of the following school year.  Please click here for cost and enrollment information as a Qualifying Life Event.