SCHOOL OF VISUAL ARTS
STUDENT HEALTH INSURANCE PLAN

SPRING 2024 WAIVER APPEAL FORM

Important Considerations

This document must be read before you may to continue to the waiver form.
 

• Spring 2024 Waiver Appeal Process: If you missed the spring waiver deadline of February 5, 2024, you may submit this missed waiver deadline appeal form for consideration.The deadline to submit a missed waiver deadline appeal is April 30, 2024. You are only eligible for ONE waiver appeal while a student at SVA. If you have used the SVA Student Health Insurance Plan since January 1, 2024, your plan will not be terminated.
  
  If your waiver appeal is approved, a late fee of $200 will be added to your student account. This fee cannot be waived.

• Please note: At this time, you have the option to waive the spring 2024 coverage period ONLY. Students are only eligible for ONE late waiver appeal during their academic career at SVA.

• Spring 2024 waiver appeal deadline is April 30, 2024. No waivers will be accepted or considered after this date.

• By waiving participation in the SVA-sponsored Student Health Insurance Plan, you are certifying that you have a current health insurance plan with medical coverage that meets or exceeds SVA’s requirements as indicated below and is effective from at least January 1, 2024 and will remain effective for the entire policy period through August 24, 2024.
   
• If your current health insurance plan does not meet all of the requirements listed below, you may not waive out of the SVA insurance plan.
   
• If your waiver is not accepted, the Health Insurance Fee will remain on your student account. If you feel your waiver was declined in error, please contact University Health Plans at 1-833-251-1138 or info@univhealthplans.com.
   
• You will receive an online receipt and email confirmation upon submission of this waiver appeal form. You should retain as evidence that you have submitted the waiver appeal form.

Waiver Requirements

1. The policy must be a US health insurance plan that is filed and approved in the United States
   
   Please note: Health insurance plans marketed solely to international students are often not filed and approved in the United States, have limited benefits, provider networks and/or coverage periods that do not comply with the SVA waiver requirements. GBG Insurance, HDL Global Specialty, ISO, PGH (United), PSI, Student Medicover, Bajaj Allianz and Tata AIG are examples of companies that do not meet the waiver requirements (these plans are not Affordable Care Act compliant, are not filed in the U.S. and are not eligible for a waiver.)
    

2. I confirm that I have a current health insurance plan that includes coverage for:

   • Office visits
   • Prescription drugs
   • Immunizations
   • Routine physical exams
   • Hospitalization, and emergency services.
   • Injuries (resulting from accidents)
   • Inpatient and Outpatient Mental/Behavioral Health Care
   • Pre-existing conditions
      
3. My current health insurance plan is not a short-term limited duration and/or travel plan only.
    
4. My current health insurance plan offers an unlimited maximum benefit for coverage of necessary medical expenses each policy year.
    
5. My current health insurance plan includes a nationwide network of Preferred Providers, guaranteeing acceptance of my insurance plan, especially within the New York City area.
    
6. My current health insurance plan provides coverage anywhere in the world, including medical evacuation, repatriation, and travel assistance services while I am away from campus for academics, research, work, or vacation.
    
7. My current health insurance plan does not limit my coverage to emergency conditions only while in the area of the School of Visual Arts campus, but provides all of the coverage described in #2 above while in the area of the School of Visual Arts campus.

By submitting the online waiver appeal form, I acknowledge that if it is approved, I am legally responsible for any and all medical expenses I incur during the entire chosen policy period and that neither SVA nor its Student Health Insurance Plan will be held responsible for any of my medical expenses once I waive coverage. I certify that I have comparable health insurance coverage which meets or exceeds SVA’s requirements as outlined above and which will be in force until at least August 24, 2024.

For more information on submitting a waiver appeal, please contact University Health Plans at 1-833-251-1138 or info@univhealthplans.com.

The spring 2024 waiver appeal deadline is April 30, 2024. No waivers will be accepted or considered after this date.

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