In order for students to have coverage under the policy, three (3) items should be reported to Risk Management at System Office (SO):

• Blanket Enrollment Form
• Class Roster
• Insurance Fee Roster.   

Instructions to Complete Blanket Enrollment Form

Complete the top section of Blanket Enrollment Form.  

1. List the number of students to be insured by each health specialty category. The Blanket Enrollment form classifies students as:
   • Low Risk (Section A) for most disciplines or
   • High Risk (Section B) for specialties in areas such as EMT/Paramedic.
2. Refer to the following schedule that includes rates for Fall, Spring and Summer registration.  Additional insured coverage for  LSCS is included in the "Combined Total Rate." 

   	Combined Total Rate
   Period	(A) Low Risk	(B) High Risk
   Fall Enrollment 12 Months (Sept-Aug)	19.00	77.00
   Spring Enrollment 8 Months (Jan-Aug)	12.00	49.00
   Summer Enrollment 3 Months (Jun-Aug)	5.00	20.00

3. Calculate the Total Low Risk and Total High Risk premiums. 

4. To the Blanket Enrollment Form, attach the Section Roster (run as of the "Day of Record" and lists the names and IDs of each student), and the Insurance Fee Class Roster.     
5. Send forms electronically or through interoffice mail to the Risk Management primary contact at System Office (SO).