Insurance Refund/Waiver Request Form
WAVIER: ONLY for use by government sponsored students (i.e. SACM or UAE), students covered under a parent/spouse employed by a U.S. employer, or students on active OPT insured through an employer plan.
REFUND: Eligibility is subject to review; only available up to 45 days from coverage start or date of purchase, whichever is first. Student who have coverage as described above (waiver) or who have requested Termination - Authorized early withdrawal and have returned or will be returning to their home country immediately.
Read the instructions on the form carefully to determine if you are eligible for a refund or a waiver.