Forms

Health Insurance
Form DESCRIPTION
Health Insurance Temporary Absence Waiver Request Form

This form is used to request a waiver of the mandatory insurance because you will be outside the US for at least three entire calendar months.

International Health Insurance Plan Change Form

This form is used to request changes to your existing U-M International Student/Scholar Health Insurance coverage, such as a change to the coverage end date, the addition of a dependent, etc.

International Health Insurance Plan Continuation Enrollment Form

This form is used by international students and scholars who would like to continue their U-M International Student/Scholar Health Insurance Plan coverage, but are no longer eligible for the plan because their status as a U-M F-1 student or J-1 student or scholar has ended. Use this form to request up to three months of continued coverage.

International Health Insurance Waiver Request Form

This form is used to request a waiver of the mandatory insurance requirement for F-1 and J-1 students or scholars whose Forms I-20 or DS-2019 were issued by U-M. If you are currently on F-1 Optional Practical Training, submit your OPT insurance waiver request through M-Passport. 

International Health Insurance Waiver Request Form (AT)

This form is used to request cancellation of your international health insurance coverage because you are now covered by health insurance provided by your Academic Training employer. If you are not a J-1 student currently on post-completion Academic Training, please do not use this form.