BECKER COLLEGE
STUDENT HEALTH INSURANCE PLAN

GRADUATE AND TRADITIONAL UNDERGRADUATE STUDENTS
2017-2018 POLICY YEAR

 SPRING WAIVER FORM

All newly eligible Spring 2018 students taking 9 or more credits who wish to waive the Annual 2017-2018 Student Health Insurance Plan must give notice of their decision by completing the Waiver Form by the deadline of January 25, 2018.

If you have any questions about the waiver process, please contact University Health Plans at 800-437-6448 or by email at info@universityhealthplans.com.


Complete the following fields to continue to the Waiver Form.

Please be sure to use the correct Student ID and Date of Birth. If they are not correct, the insurance charge will not be removed from your account.

Asterisk (*) denotes required field

STUDENT INFORMATION
 
first name: *
last name: *
student ID: * (7 digits including leading zeros)
date of birth: * (MM/DD/YYYY)