Order Prescription Refills. Track Your History Online. And a whole lot more.

Find a Doctor
Find a doctor or hospital locally or across the country.
What is Empire's 360° Health® program?
A total health solution that helps members become more healthy, or live better with a condition, while lowering the cost of health care.
Learn More

College-Student Dependents Health Benefits

As your covered dependent prepares to attend or attends, college, it's important to make certain that he or she continues to receive health benefits. Please be sure to check your benefit book to confirm dependent full-time student eligibility terms.  
Members with covered college student dependents who are under the maximum dependent full-time student coverage age must submit a Student Coverage Questionnaire by December each year to ensure their dependents’ continued health benefits.  
In order for college student dependents under the maximum coverage age to retain coverage, Empire requires that your child attend an accredited school of higher learning full-time, and that you submit the Student Coverage Questionnaire by December 31 of each year to establish eligibility for continued enrollment.  
Download and print the Student Coverage Questionnaire Form, which is also available in the "Forms and Documents" page under Member Services.  
You are responsible for completing the questionnaire and certifying that the information is correct. The form requires, in addition to basic information:  

the name and address of the educational institution

type of institution, and

expected date of the student’s graduation or completion

Completed and signed forms should be faxed or mailed to the following:  

FAX to:


MAIL to:

PO Box 1407
Church Street Station
New York, NY 10008-1407 
©2015 Empire BlueCross BlueShield

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. All external sites will open in a new browser window. Please view our Website Privacy Policy for more information.