Ithaca College
STUDENT HEALTH INSURANCE PLAN
2025-2026 POLICY YEAR
Spring Opt-Out Request Form
This form is for students enrolled in the Annual Ithaca Student Health Insurance Plan.
Please note the Late Annual Waiver Appeal deadline was extended to October 15, 2025. This is the Spring Opt-Out Request Form.
If you are a new student beginning classes in the Spring, you need to submit the Spring Waiver Form (when it becomes available). This form is only for students who were enrolled in the plan for Fall semester for Annual Coverage.
TO CONTINUE THE SPRING OPT-OUT REQUEST PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:
Please Note: You must enter your Ithaca College email address below. Entering your personal email address will not allow you access to the waiver form. You must activate your Ithaca College Netpass/e-mail account prior to completing this process.
