Montclair State University
STUDENT HEALTH INSURANCE PLAN

Waiver Appeal Form
2024-2025 Academic Year

It is important for you to make an informed health assessment each year. For instance, have your health needs changed? Will you be participating in a study abroad program? Do you have access to a network that covers you throughout the country and do you have coverage for emergencies? Make sure you have appropriate health coverage so that an unexpected illness or accident doesn’t hold back your wellness or academic success.

You may waive coverage under this plan if you have health insurance that meets all of Montclair State University’s insurance plan requirements. You will need to provide information about your coverage. An accepted waiver applies to the full academic year during which it is filed.

The waiver appeal deadline is October 9, 2024.

PLEASE FILL OUT THE REQUIRED FIELDS BELOW:

Please note, your Montclair State University student ID# begins with an "M" followed by 8 digits. You must include the UPPERCASE "M" in your student ID number when entering it below.

BLOOMFIELD STUDENTS: You must use your Montclair ID number that starts with the "M". You cannot use your Bloomfield ID number.