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 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.

PEA's Student Accident and Sickness Insurance

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

• Coverage for a broad range of medical services provided by specialists and hospitals, laboratory and x-ray
• $1,000 pharmacy benefit
• Coordination of the payment of claims with your health insurance plans
• 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 Student Accident and Sickness Insurance Plan.

Learn more about how to prepare for school…

• Checklist for new students
• Checklist for returning students

Additional Medical Forms for:

•  Summer School Medical Form
•  Study Tours Medical Form
•  Term Abroad Medical Form
• Student Accident and Sickness Insurance Claim Form
• Student Accident and Sickness Cover Letter/Policy Number

Checklist for New Students:

• Health Report Form 2008-09 (new students) –  to be returned to Health Services by July 1st, 2008
• Private Health Insurance Form –  to be returned to Health Services by July 1st, 2008
• Student Health Insurance Accept/Decline Form (new students) - to be returned to Accounting by May 10th, 2008 
• Copy of Front and Back of Insurance Card and Prescription Card (see Private Health Insurance Form –  to be returned by July 1st, 2008
• Patients' Rights and Responsibilities
• Ophthalmologist or Optometrist Report
• Potassium Iodine (KI) Waiver Form- to be returned only as a refusal

Checklist for Returning Students:

• Health Report Form 2008-09 (returning students) – to be returned to Health Services by August 1st, 2008
• Private Health Insurance Form - to be returned to Health Services by August 1st, 2008
• Student Health Insurance Accept/Decline Form (returning students)  – to be returned to Accounting by April 1st, 2008 
• Copy of Front and Back of Insurance Card and Prescription Card (see Private Health Insurance Form) – to be returned by August 1st, 2008 
• Patients' Rights and Responsibilities
• Ophthalmologist or Optometrist Report
• Potassium Iodine (KI) Waiver Form- to be returned only as a refusal