MGH INSTITUTE OF HEALTH PROFESSIONS
Student Health Insurance Plan
TERMINATION REQUEST FORM
2016-2017 Policy Year
(May 1, 2016, through April 30, 2017)
The Termination Request Form is only for students who are currently enrolled in the student health insurance plan (SHIP).
The Termination Request Form is used in the following situations:
- You are currently enrolled in the SHIP for the 2016-2017 policy year, but now have other health insurance coverage and want to cancel your SHIP coverage.
- You have previously submitted an enrollment form to cover yourself and your dependents under the SHIP for the 2016-2017 policy year, but your dependent(s) now have other coverage and/or no longer need to be enrolled in the SHIP.
IMPORTANT: All students are initially billed for the SHIP, so seeing the SHIP premium on your student account does not mean that you have been enrolled in the SHIP. If you have not yet submitted an online waiver or enrollment form for the 2016-2017 policy year and would like to waive the student health insurance plan, you need to submit the online waiver form.