Simmons University

Undergraduate Student Health Insurance Plan 
Spring Waiver Form 
January 1, 2020 - August 14, 2020


TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:

Please note if you just registered for classes you will have to wait a week to complete the form. Simmons University updates the authorization list for access to the forms once a week.

**The MassHealth Premium Assistance (MHPA) Program is not available through Simmons University for the 2019-2020 academic year. MassHealth will no longer pay for the Simmons University Blue Cross Blue Shield (BCBS) Student Health Plan for MassHealth members. If you have questions about MHPA please contact MHPA at 855-273-5903.**

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