Health Insurance and Medical Forms

Health And Wellness Fee

Our Health and Wellness Fee, which is billed annually, offers 24/7 accessibility to a broad range of services provided by our team of health care professionals at the Lamont  Health and Wellness Center.  Additional fees will be charged for medications, medical chaperones and some immunizations which can not be attained for free from the State of NH.  The services of health care providers not on our staff and annual physicals are not covered under this fee.

The Student Accident and Sickness Insurance plan is specifically designed to meet the needs of our students. The Plan provides:

• Full primary coverage for a broad range of medical services provided by specialists and hospitals, laboratory and x-ray
• $1,000 pharmacy benefit
• Wellness benefits 
• No deductibles

Parents with U.S. family health insurance plans and coverage acceptable to Exeter may opt out of the Plan. For more information, see the Parents' Frequently Asked Questions about the Student Accident and Sickness Plan as well as the complete 2012-13 Student Accident and Sickness Insurance Plan Brochure.

Additional Medical Forms for:

• Summer School Medical Form
• International Health Insurance and Health Form:  Spring Break and Summer Trips
• International Health Insurance and Health Form: Term Abroad Trips
• Student Accident and Sickness Insurance Claim Form
• Student Accident and Sickness Cover Letter/Policy Number
• International Travel Health Insurance Brochure

Checklist for New Students:

• Health Report Form 2012-2013 (new students) –  to be returned to Health Services by July 1st, 2012
• TB Supplement Form  - to be returned to Health Services by July 1st, 2012
• Private Health Insurance Coverage Form –  to be returned to Health Services by July 1st, 2012  
• Prescription Coverage Form –  to be returned by July 1st, 2012
• Patients' Rights and Responsibilities
• Ophthalmologist or Optometrist Report 
• Potassium Iodine (KI) Waiver Form- to be returned only as a refusal

Checklist for Returning Students: