RUTGERS UNIVERSITY

2017-2018 Student Health Insurance Plan
FULL TIME SPRING WAIVER FORM

PLEASE NOTE: THIS IS FOR SPRING ONLY - YOU MUST ENROLL OR WAIVE AGAIN FOR THE NEXT FALL TERM

All full time Undergraduate Students taking 12 or more credit hours and all full time Graduate Students taking 9 or more credit hours* are required to have comprehensive Health Insurance each semester.  Student insurance eligibility may be affected if an enrollment status change occurs (part time to full time or full time to part time).  Students must actively attend classes for at least 31 days after the date for which coverage period is purchased.

*full time graduate students as defined by the student’s department could require you to be registered for 12 credits, example: Rutgers Business School, Rutgers Law School.

Eligible students who have other health insurance coverage (i.e. under a parent’s or employer’s plan) and do not want to be enrolled in the Student Health Insurance Plan must submit an online waiver form documenting their other coverage prior to the posted deadline each semester. Once a waiver form is successfully submitted, if approved, the insurance charge is removed from the student’s account. Once the term bills are processing, please allow approximately 4 business days for the insurance charge to be removed.

DEADLINE: February 2, 2018.  


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

IF YOU HAVE ALREADY BEEN ENROLLED AND HAVE INCURRED CLAIMS UNDER THE STUDENT HEALTH INSURANCE PLAN, YOUR COVERAGE CANNOT BE CANCELLED AND YOU WILL RE RESPONSIBLE FOR THE FULL PREMIUM.

The charge will be removed from your term bill within 4 business days after waiving.

date of birth: (MM/DD/YYYY)
student ID: