Military Special Circumstance Health Insurance Waiver Form

the following form should be used annually by veteran students who are eligible to waive health insurance by meeting waiver criteria.

Form Use

The Veteran Office must verify your military status, prior2020欧洲杯体育直播投注 to forwarding your waiver request.

once your status has been verified, the insurance office will receive your waiver request for processing.

ub requires that all domestic undergraduates at 12+ credit hours and all domestic graduate/professional students at 9+ credit hours carry health insurance.  the ub student health insurance program is mandatory for students at the above credit hour thresholds and is assessed as a mandatory fee to the student’s ub account and billed on the tuition statement.

annual qualified waiver of this mandatory fee and coverage is available to those students that carry private health insurance coverage that both meets the requirements for attendance and is in full effect by the first day of classes for the semester during which waiver is requested.

though the standard waiver process is available online, administration does realize that certain circumstances cannot be administered by the automated online system. by completing and returning this form to veteran services, you are requesting that veteran services and the ub student health insurance office review your circumstances to determine if exception to ub policy and procedure as per assessment and waiver of the health insurance requirement can be granted based on all information currently available.

Accessibility

* The University at Buffalo is committed to ensuring equal access to information that is presented online. As part of this commitment, university web content must be accessible to everyone, including individuals with physical, sensory, or cognitive impairments, with or without the use of assistive technology. If you encounter an accessibility issue when completing this form, please contact the health insurance office.

To Submit this Form, or Get Help

University at Buffalo
321 Student Union, North Campus
Buffalo, NY 14260

phone: (716) 829-5586

For help understanding and navigating the health insurance process.

1 Capen
University at Buffalo
Buffalo, NY 14260-2100

phone: (716) 645-3036