Indiana University
Student Academic Appointees, Appointed
Postdoctoral Fellows, & Fellowship Recipients

Waiver Form
2025-2026 Academic Year

If you have a health insurance policy that provides comprehensive benefits near the campus at the start of the term, you can use this form to opt out of the IU Plan.

To waive this plan, you will need to provide documentation from your health insurance plan. Please have a copy of your insurance ID card and a copy of your plan summary available to provide information on the waiver form and to download.

Once you opt out of the plan, you cannot voluntarily re-enroll later unless you experience an IRS qualifying life event and qualify for special enrollment rights.

By waiving this plan, you will be certifying that the coverage under your health plan is comparable to coverage under SAA and Fellowship Recipient plan, and you understand that you are responsible for your medical expenses. You will also certify that your insurance coverage will remain in effect, providing coverage in the geographic area surrounding the Indiana University campus during the 2025-2026 academic year. The submission of your waiver form, including all information included, constitutes truthful and accurate statements.

If you are waiving the SAA and Fellowship Recipient plan to enroll on another IU student insurance plan you must take further action to be enrolled on those plans.

• To enroll in the Professional Insurance plan, contact the IU Student Insurance office at studenhc@iu.edu.
• To enroll in the International Student Insurance plan, you must inform the international office on your campus that you need to be enrolled.

A new waiver is required to be submitted each academic year.

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