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Risk Strategies - University Health Plans

SALEM STATE UNIVERSITY
STUDENT HEALTH INSURANCE PLAN

Annual Waiver Form 
2024-2025 Academic Year

Students opting out of the Salem State SHIP must be insured by a plan that:
  • Is filed and approved in the U.S. and be compliant with the Affordable Care Act (ACA)
  • Provides comprehensive, non-emergency benefits in the geographical area surrounding the school.

Plans that do not meet these requirements include short-term medical plans, healthcare sharing plans, insurance plans from foreign health care systems, travel plans, and plans available to international students only. Generally, only plans acquired through U.S. employment or purchased from the local state marketplaces will be filed and approved in the U.S. and compliant with the ACA. Examples of plans marketed to international students that do not meet the requirements include GBG Insurance, HDL Global Specialty, ISO, Tigerless, PGH (United), PSI, Student Medicover, and Tata AIG.

Not all U.S. health plans provide national coverage. Many out-of-state HMO, EPO, and Medicaid plans will not provide comprehensive non-emergency benefits in the geographical area surrounding the school.

Students covered by an out-of-state plan should contact their insurance company and confirm if the plan’s non-emergency care network includes Massachusetts. If it does not, students should ask if they can apply for an away-from-home rider, which many insurance companies offer these riders for students studying away from home. If the plan cannot provide non-emergency coverage in MA, the student cannot waive.

Waiver forms may be reviewed, and if the plan does not meet the requirements, you will be notified that their waiver form is not accepted.

If the student is a minor, then the parent or guardian must complete this form.

To continue the waiver process, you will need your Student ID number, which can be found on your tuition bill, preceded by the letter "S" (example: S0123456). This ID number is not your social security number or your Connect Card number.

Asterisk (*) denotes required field

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