Request for Proposal

Please provide as much information as possible.

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Contact Information
* First Name:
* Last Name:
* Title:
Phone:
* Email:
* School Name:
* Address:
* City:
* State:
* Zip Code:
Preferred contact method:

Miscellaneous Information
* Estimated total number to be insured:
Do you have a Student Health Center?
What products are you interested in?
Medical Plans Dental Plans Sports Accident Plans
Discount Programs Student Assistance Program (SAP)
Would you like an Account Executive to visit?
What would you like changed in your current plan design:
To provide the most accurate quote, please send us an email with your last three years’ of claim history as well as the last three years’ plan outlines (brochures).

Company Information

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Students

Parents

University Administrators

Copyright © 2010 Aetna Student Health. One Charles Park, Cambridge, MA 02142-1254. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. Massachusetts license number: 10041444. California license number: OB84599.

Fully insured student health insurance plans are underwritten by Aetna Life Insurance Company (ALIC) and administered by Chickering Claims Administrators, Inc. (CCA). Self insured plans are funded by the applicable school, with claims administration services provided by CCA. Aetna Student HealthSM is the brand name for products and services provided by ALIC and CCA and their applicable affiliated companies.