Get a Quote for Your School

Thank you for visiting MyStudentMedical. In order to provide you with a near accurate quote, please provide answers to the following questions and we will get back to you shortly. If you need any clarification on our form below, please contact one of our Student Health Representatives by email at mystudentmedical@ajfusa.com or by phone at 800.734.9326
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Tell us a little about yourself
School affiliation
Share your school's address
Current enrollment
Rates charged over the past 4 years
Number of enrollees over the past 4 years
Provider information
Top 5 medical providers used by students:
Health services center

Does your school have an on-campus student health services center?


Please provide a list of services available at the Health center

Attachments

To help us provide you with a more accurate quote for the School's Student Health Insurance Plan, please also provide the following:

Plan brochures for the most recent 4 years

File formats: PDF, DOC, JPG under 2MB

Claim reports for the most recent 4 years (which show claim payments by benefit type for each year reported).

File formats: PDF, DOC, JPG under 2MB