Students who are eligible to be charged for the Student Health Insurance Plan but have other comparable coverage may decline the PMC plan by completing this waiver form. Requirements of comparable coverage include:
Please Note: Health Safety Net, MassHealth Limited, and Children's Medical Security Plan may not be used to waive participation in the Pine Manor College Student Health Insurance Plan.
The deadline to waive the PMC plan has been extended to September 28, 2018.
Students who do not submit a waiver form will be enrolled in the PMC plan and responsible for the premium charged to their student accounts.
Should you have questions about the waiver, please contact University Health Plans at email@example.com or 800-437-6448.
If you have determined your plan to be comparable, please fill in the fields below to continue: