Fill out (by handwriting or typing) a copy of the 2-page form
containing: fax cover sheet and acknowledgement of waiver forms.
Attach the forms with your certificate of credible coverage.
You must prove you have other coverage by producing a certificate of
credible coverage obtained from your managed care organization,
insurance company, or a letter to verify your enrollment from your
current insurance company.
Submit all documentseither:
In-person to the Student Health Benefits Office at Boynton Health
Service, 410 Church Street S. E., Room N323, Minneapolis, MN 55455
orby fax Student Health Benefit Plan Office at 612-626-5183
Note: At this time, Academic Health Center
students will not be able to update insurance information through the
University's web registration system.
The Student Health Benefits Office will contact you with the
decision on your petition within 2 weeks of filing.
Specific deadlines to waive for every semester can be found on the
website of the
Office of the
Registrar.
Your waiver
will be valid for two years. Should you lose coverage during the
period you have been waived, you may enroll in the plan within
30 days of losing coverage by providing proof of involuntary
loss of coverage from your insurance company.
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If you have other questions or concerns about the Student
Health Benefit Plan, please contact:
Student Health Benefit Plan Office Boynton Health
Service
Minneapolis, MN 55455
e-mail:
studins@bhs.umn.edu
Phone: 612-624-0627 or 1-800-232-9017 Fax: 612-626-5183
or 1800-624-9881