Lehigh University
Student Health Insurance Plan

STUDENT WAIVER FORM
2018-2019 POLICY YEAR

All undergraduate matriculating students registered for five (5) or more credits, undergraduate non-matriculating students (non-degree/General College Division) registered for twelve (12) or more credits, graduate students enrolled in a degree seeking on-campus based program and registered for nine (9) or more credits, and graduate students registered for dissertation credits registered for the Fall 2018 semester are required to show evidence of an existing creditable health insurance policy, otherwise, they will be automatically enrolled in the university-sponsored Student Health Insurance Plan for the 2018-2019 Policy Year (8/1/18-7/31/19).

If you already have another health insurance plan that provides comprehensive coverage in the Lehigh area for inpatient and outpatient services in both emergency and non-emergency situations, you may opt out of the Lehigh University Student Health Insurance Plan by submitting this waiver form by the deadline.

All Lehigh international students on an F-1 or J-1 visa are not permitted to drop coverage by submitting a waiver form unless a student is covered under a family member’s U.S. plan or foreign government insurance plan. International students should contact Lehigh’s Office of International Students & Scholars (610) 758-4859 to verify if you qualify for a waiver.

If you do not complete a waiver or enrollment form by the deadline, you will be enrolled in the Lehigh plan and will remain responsible for the associated premium of $1,918 on your student bill.

If the insurance waiver is completed by July 1st the charge and waiver will appear on the July bill.

Once your waiver is completed, please allow 2-3 business days to see the credit posted to your Bursar Account.

Waivers that occur after the July 31st may be subject to a late processing fee of $25.
 



To continue the waiver process, please fill out the required fields below:


***STEP 1 OF 3***

date of birth: (MM/DD/YYYY)
LIN (Lehigh Identification Number):