Student Health Insurance Plan
UNDERGRADUATE STUDENT WAIVER FORM
2016-2017 POLICY YEAR
All undergraduate students registered for 4+ credits for the Fall 2016 semester are required to show evidence of an existing creditable health insurance policy, otherwise, they will be automatically enrolled in the university-sponsored Student Health Insurance Plan for the 2016-2017 Policy Year (8/1/16-7/31/17).
If you are an undergraduate student registered for 4+ credits and already have another health insurance plan that provides comprehensive coverage in the Lehigh area for inpatient and outpatient services in both emergency and non-emergency situations, you may opt out of the Lehigh University Student Health Insurance Plan by submitting this waiver form by the deadline.
If you do not complete a waiver or enrollment form by the deadline, you will be enrolled in the Lehigh plan and will remain responsible for the associated premium of $XXXX on your student bill.
The Waiver Deadline is September XX, 2016.
To continue the enrollment process, please fill out the required fields below:
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