SARAH LAWRENCE COLLEGE
STUDENT HEALTH INSURANCE PLAN
WAIVER FORM

2015-2016 Annual Term - Waiver Form


IMPORTANT NOTICE: Sarah Lawrence College automatically enrolls all registered students in the Student Health Insurance Plan. You are REQUIRED to participate in, and pay for, the Student Health Insurance plan unless proof of COMPARABLE COVERAGE is provided below. NOTE: ALL NEW AND RETURNING REGISTERED STUDENTS FOR THE FALL 2015 SEMESTER MUST complete this online form and submit it by August 1, 2015. If you fail to complete this Waiver form by the deadline date you will be enrolled in and charged $2,848 for Annual Term coverage through the Sarah Lawrence College Student Health Insurance Plan.

INTERNATIONAL STUDENTS: If you have comparable coverage from a domestic health insurance company with claims paid in the United States, you are eligible to waive the mandatory Student Health Insurance Plan, and have the health insurance charge removed from your student account. Non U.S. Based health Insurance companies or coverage provided in countries with socialized medicine, including Canada, is NOT considered comparable coverage, and you are REQUIRED to enroll in the Sarah Lawrence College Student Health Insurance Plan.

Please take a few minutes to review your current policy and make sure you are adequately covered. Many HMOs and PPOs provide limited coverage for students traveling away from their service area, and most employer plans will not cover dependents beyond a certain age. If you are not adequately insured while you are at school, you will not be allowed to waive. If you are not sure, please contact your current carrier. If you have COMPARABLE coverage benefits to the Sarah Lawrence College Student Health Insurance Plan, please continue to fill out the required fields below. Please make sure that you have a copy of your insurance card before proceeding to the waiver form.

Please Note: Your SLC student ID# consists of 9 digits following 000XXXXXX. Please do not enter your social security number.

first name:
last name:
student ID: