University of Bridgeport
STUDENT HEALTH INSURANCE PLAN
Spring Waiver Form
Full-Time Undergraduate Students, Physician Assistant Students, and Residents
2017-2018 Academic Year
You are electing to waive the student health insurance coverage provided to you by the University of Bridgeport. You understand that on the following page you will be asked to enter your current health insurance information that meets or exceeds the minimum coverage requirements of the University of Bridgeport.
PLEASE NOTE: INTERNATIONAL STUDENTS ARE NOT ABLE TO WAIVE THIS HEALTH INSURANCE.
Helpful tips for completing your waiver:
- The deadline for new spring students to waive the University of Bridgeport Student Health Plan is February 15, 2017.
- Please have your current health insurance ID card and a summary of your plan benefits available as you will need this information to waive the plan.
- Please make sure providers in Connecticut are in your insurance network.
- If you are unable to accurately answer the questions on the online waiver form, please contact your insurance company for the necessary information. If the answers you provide indicates that you do not have comparable insurance coverage, your waiver will be denied.
- If your waiver cannot be processed, you will be contacted via email from firstname.lastname@example.org. Please open any mail from email@example.com as it will contain important information regarding your waiver.
- Upon proper completion of the on-line waiver, you will receive an email confirmation, and then an approval or rejection. If that email is not received, you must again complete the online waiver. You will need to contact firstname.lastname@example.org for assistance.
Please allow 2-3 weeks for charges to be removed from your UB account. DO NOT call for verification that your information has been received. Your email confirmation is your receipt.
Any question or concerns may be directed to email@example.com. Please be sure to include your name and Student ID in your email.
If you would like to waive out of the University of Bridgeport Student Health Insurance Plan, please continue and complete the following online waiver form. To access the form, enter your UB Student ID and date of birth below. Your UB ID is a 7 digit number. You may need to add a zero if your number is less than 7 digits.
If you do not know your UB student ID, please contact the Bursars Office at UB 203-576-4568.