By my signature, I affirm that I am currently insured under the above, comparable insurance policy and I have therefore chosen to waive the University-sponsored Student Health Insurance Plan. I understand that this information may be initially verified, and if my plan does not meet comparable coverage requirements, I will automatically be charged for and enrolled in the Student Health Insurance Plan. I acknowledge that it is my responsibility to continue to be insured throughout my attendance at RFUMS.
I certify that the information supplied is correct, and I am responsible for any incorrect information, whether intentional or otherwise. I understand I am legally responsible for any medical expenses incurred during my enrollment at the University, and that the University and its medical insurance program will not be responsible for any of my medical expenses.
Note: A student, who initially waived coverage but subsequently experiences ineligibility under another creditable coverage, may elect to enroll for coverage under the University-sponsored Student Health Insurance Plan within 31 days of the date of ineligibility under another creditable coverage. The student’s coverage will then become effective on the latest of the following dates: 1) the effective date of the University-sponsored Student Health Insurance Plan; 2) the date for which the first premium for the student’s coverage is received by the insurance company providing the University-sponsored Student Health Insurance Plan; or 3) the date the student becomes eligible for coverage. If enrollment for coverage under the University-sponsored Student Health Insurance Plan is made more than 31 days following the date the student became eligible, the student’s insurance will become effective only if and when the insurance company providing the University- sponsored Student Health Insurance Plan gives its written consent.