Westfield State University

STUDENT HEALTH INSURANCE PLAN
2022-2023 ACADEMIC YEAR
SPRING WAIVER FORM

Eligible students who have other health insurance coverage (i.e. under a parent’s or employer’s plan) and do not want to be enrolled in the Student Health Insurance Plan must submit an online waiver form documenting their other coverage prior to the posted deadline each academic year. Please allow approximately 7 business days for the insurance charge to be removed from your student account.

DEADLINE: FEBRUARY 28, 2023.

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

 (MM/DD/YYYY)