STUDENT HEALTH INSURANCE PLAN
Should you have any questions, please contact University Health Plans at firstname.lastname@example.org or 800-437-6448.
ALL NEWLY ELIGIBLE SPRING 2015 STUDENTS MUST COMPLETE EITHER A WAIVER FORM OR ENROLLMENT FORM
BY THE DEADLINE OF DECEMBER 12, 2014, FOR THE 2014-2015 POLICY YEAR.
WAIVER FORM: Complete this form if you have other, comparable coverage and want to remove the $1,145 insurance charge from your student bill.
ENROLLMENT FORM: Complete this form if you want to expedite the processing of your Student Health Insurance enrollment. If you do not
complete this form by the deadline, your information will not be added to the insurance plan system until after the effective date of 1/1/15.
VOLUNTARY INSURANCE PLANS
Please select one of the plans below to proceed to the benefit information, provider search, and enrollment form.
You do not need to purchase or be eligible for the Student Health Insurance Plan to purchase one of the voluntary plans below.