SCHOOL OF VISUAL ARTS
STUDENT HEALTH INSURANCE PLAN
2019-2020 Policy Year Waiver Form
(August 25, 2019 - August 24, 2020)
This document must be read before you may to continue to the waiver form.
- The waiver process is an annual one. The waiver deadline for the 2019-2020 policy year is October 1, 2019.
- By waiving participation in the SVA-sponsored Student Health Insurance Plan, you are certifying that you have current health insurance plan with medical coverage that meets or exceeds SVA’s requirements as indicated below.
- If your current health insurance plan does not meet all of the requirements listed below, you may not waive out of the SVA insurance plan.
- You will receive an online receipt and email confirming submission of the waiver form, which you should retain as evidence that you have successfully submitted the waiver form.
- If your waiver is not accepted, you will receive and email confirming you will remain enrolled and the Health Insurance Fee will remain on your student account. If you feel your waiver was declined in error, please contact University Health Plans at 1-800-437-6448 or email@example.com.
- The policy must be a US health insurance plan that is filed and approved in the United States
I confirm that I have a current health insurance plan that includes coverage for:
- Office visits
- Prescription drugs
- Routine physical exams
- Hospitalization, and emergency services.
- Injuries (resulting from accidents)
- Inpatient and Outpatient Mental/Behavioral Health Care
- My current health insurance plan is not a short-term limited duration travel plan only.
- My current health insurance plan offers an unlimited maximum benefit for coverage of necessary medical expenses each policy year.
- My current health insurance plan includes a nationwide network of Preferred Providers, guaranteeing acceptance of my insurance plan, especially within the New York City area.
- My current health insurance plan provides coverage anywhere in the world, including medical evacuation, repatriation, and travel assistance services while I am away from campus for academics, research, work, or vacation.
- My current health insurance plan does not limit my coverage to emergency conditions only while in the area of the School of Visual Arts campus, but provides all of the coverage described in #2 above while in the area of the School of Visual Arts campus.
By submitting the online waiver form, I acknowledge that I am legally responsible for any and all medical expenses I incur during the spring 2019 policy period and that neither SVA nor its Student Health Insurance Plan will be held responsible for any of my medical expenses once I waive coverage. I certify that I have comparable health insurance coverage which meets or exceeds SVA’s requirements as outlined above and which will be in force until August 24, 2020.
THE WAIVER DEADLINE FOR THE 2019-2020 POLICY YEAR IS OCTOBER 1, 2019.
TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW: