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Dartmouth Student Group Health Plan

 1415 dsghp summary
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2015 - 2016 Insurance Requirement and Waiver Process

Coming Soon!


2014 - 2015 Insurance Requirement and Waiver Process

Dartmouth college requires all students who are classified as active in the College Student Information System (Banner), including students not taking classes or on a leave term, to have health insurance meeting specified standards of coverage.  Eligible students are automatically enrolled in the Dartmouth Student Group Health Plan (DSGHP) each academic year and the cost of the plan is billed to their tuition account.  Students who have insurance coverage that meets Dartmouth's insurance requirements may apply to waive the automatic enrollment into the DSGHP by completing the insurance waiver petition below. 

DSGHP Annual Mailings:

Incoming Students: 
  • Undergraduates: Will be mailed via postal mail to the permanent address listed in Banner.
  • Graduates: Will be mailed via e-mail to the e-mail address provided on the student's Dartmouth application from
Returning Students:
  • Undergraduates: Will be mailed via postal mail to the permanent address listed in Banner.
  • Graduates: Will be mailed via e-mail to the student's college e-mail address from

Click here for the 2014 - 2015 waiver requirements.

Waiver Submission

There are several ways to submit a completed DSGHP waiver petition.

  • A paper waiver submitted through the postal mail, 
  • A paper waiver scanned and sent as an e-mail enclosure,
  • A paper waiver dropped off at the DSGHP Office, or
  • A paper waiver faxed.
Paper Waiver

1) Fill in the student's name, class and DID# in the sections indicated on the attached waiver.
          * New students who do not know their DID# yet may enter their date of birth in this section.
2) Fill in the insurance company name, claim address, complete member identification number (be sure to include any letters, dots or dashes that may be part of it), group number, subscriber name, subscriber's date of birth and inquiry phone number.
          * This information is located on your insurance identification card.
3) Answer yes or no to each of the nine (9) questions regarding your insurance coverage. If you are unsure of the answers we suggest you either contact your insurance representative or refer to your insurance plan document.
4) Either the student, parent, legal guardian or policy holder needs to sign and date the waiver.
5) Submit the completed waiver petition to the Dartmouth Student Group Health Plan Office via one of the four (4) methods below by July 1, 2014 to avoid late fees.
          a. Mailing Address: Waiver Processor, 5 Rope Ferry Road, HB# 6143, Hanover, NH 03755‐1421
          b. Office Drop Off: 37 Dewey Field Road, 4th Floor, Rooms 403 & 408
          c. E‐mail: Dartmouth.Student.Health.Plan@Dartmouth.EDU
          d. Fax: (603) 646‐8893
6) The Dartmouth Student Group Health Plan Office will send an e‐mail notification when the waiver has been received and a written notification to the home postal address once the waiver has been approved or denied.

2014-2015 DSGHP Coverage Information

Period Of Coverage (Plan Year)
  • New First Time Students:   August 1, 2014 - August 31, 2015
  • Returning Students:          September 1, 2014 - August 31, 2015
Coverage Fees (Dependent fees are in addition to the student fee)
  • Student:   $2,435.00
  • One Dependent:   $4,129.00 (plus annual spouse/domestic partner health access fee if applicable)
  • Two or More Dependents:   $5,900.00 (plus annual spouse/domestic partner health access fee if applicable)

NOTE:  A new dependent application needs to be submitted each plan year, dependent re-enrollment is not automatic.  The deadline for enrolling dependents for the 2014-2015 plan year is September 1, 2014. However, we strongly recommend that you submit a completed DSGHP dependent application by August 1, 2014 to insure that coverage will be activated and ready to use on September 1, 2014. 

DSGHP Claim Forms

All forms and brochures require Acrobat Reader.


Contact Us

  • Phone: 603/646-9438
  • Fax:  603/646-8893
  • E-mail:
  • NEW PHYSICAL LOCATION: 37 Dewey Field Road, 4th Floor, Rooms 403 & 408
    • Enter 37 Dewey Field Road entrance from the Maynard parking lot.
    • Turn left, then right and follow hallway to stairs.
    • Go up 2 flights to 4th floor.
    • At top of stairs take a right and then an immediate left, DSGHP Offices are at end of hallway.
  • Mailing Address: 5 Rope Ferry Road, Hanover, NH 03755-1421
  • Campus Mailing Address:  Hinman Box# 6143
  • Hours:
    • Fall, Winter and Spring Terms:  Monday - Friday, 8:00 AM - 4:30 PM; Closed from 12:00 PM - 1:00 PM
    • Summer Term and Breaks:  Monday - Friday, 8:00 AM - 4:00 PM; Closed 12:00 PM - 1:00 PM

Health Plan Coverage For Dartmouth Students

The DSGHP benefit program is designed to complement services available through the Dartmouth College Health Service. Spouses and domestic partners covered in the DSGHP Family Plan may use the Primary Care services at Dick's House.

Some features of the Dartmouth Student Group Health Plan, which may not be in your insurance plan, include:

  • Coordination of services by Health Service staff who know Dartmouth students
  • Complies with a general provision of the Patient Protection and Affordable Care Act (PPACA)
  • The DSGHP is purchased through Dartmouth College at preferred pricing.  Though there is no premium tax credit (subsidy) available, there are also no tax implications
  • Lower deductibles, co-payments, out-of-pocket maximums and premiums as compared to the lower cost options offered through the exchanges and marketplaces
  • Coverage for injuries sustained in intercollegiate or club sports
  • Family plan coverage for students with dependents
  • First dollar benefits for eligible Health Service expenses
  • Major medical benefits for hospitalization and physician services
  • Prescription drug benefits on campus and nationally through the Express Scripts Health Network
  • Preferred Provider Network includes the Dartmouth-Hitchcock Medical Center
  • No waiting period or pre-existing condition exclusions
  • On campus assistance with enrollment and claim submission
  • Special out-patient mental health benefits
  • World-wide coverage for care at or away from Dartmouth college, including medical evacuation and repatriation
  • Emergency medical assistance through International SOS while traveling abroad
  • Dental cost savings through the Basix Dental Savings Program
  • In some cases, Financial Aid can be used to purchase DSGHP coverage

(This brief summary does not constitute a promise of benefits on behalf of the Plan or Dartmouth College. Please see the Plan Document for a complete description of benefits, limitations, exclusions and special provisions.)

Last Updated: 3/26/15