Benjamin Franklin Institute of Technology
STUDENT HEALTH INSURANCE PLAN

2018-2019 Academic Year
Annual Waiver Form

Eligible students who have other health insurance coverage and do not wish to be enrolled in the SHIP must submit an online waiver documenting their other coverage prior to the appropriate deadline each academic year. Failure to do so will result in the student being charged for and enrolled in the SHIP.

Please note, if you are currently covered under Health Safety Net, MassHealth Limited, or Children's Medical Security Plan, you are NOT eligible to waive the Benjamin Franklin Institute of Technology Student Health Insurance plan. These types of plans are not considered comparable coverage by Massachusetts State Law, and you will be required to enroll in the Student Health Insurance Plan.

The waiver deadline is October 8th, 2018.

Asterisk (*) denotes required field

STUDENT INFORMATION

 
first name: *
last name: *
student ID: *
date of birth: * (MM/DD/YYYY)