Illinois Institute of Technology
STUDENT HEALTH INSURANCE PLAN

​Waiver Form 
2021-2022 Spring Semester

Before waiving the IL Tech Student Health Insurance Plan, review your current plan to ensure it complies with the IL Tech waiver requirements. The Spring semester waiver deadline is January 26, 2022

Students are not permitted to waive the IL Tech student health insurance plan if they have coverage through:

• A travel insurance company
• A company outside of the United States
• A company that only provides monthly coverage
• A life insurance company

Your plan must:

• Be ACA compliant, filed and approved in the US
• Provide all essential health benefits as defined by the ACA including an unlimited benefit maximum, no preexisting conditions limitation, or waiting period.
• Provide local network access for routine, non-emergency care in the Chicago area including mental health and substance abuse. Emergency only coverage in Chicago is not sufficient. 
• Have a deductible less than $6,000 for an individual or $12,000 for the family

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