Forms

Health Insurance
Form DESCRIPTION
Health Insurance Waiver Request Form (Summer Break)

This form is used to request a waiver of the mandatory insurance for Summer Break for F-1 and J-1 students who will be outside of the US for at least three entire calendar months.

Health Insurance Winter 2021 Waiver Request Form (COVID-19)

This form is used to request a waiver of the mandatory insurance for Winter Term for F-1 and J-1 students who will be outside of the US during the COVID-19 campus measures.

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 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, please use the the International Health Insurance Cancellation and Waiver Form (OPT).

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.

International Health Insurance Waiver Request Form (OPT)

This form is used to request cancellation of your international health insurance coverage because you are now covered by health insurance provided by your Optional Practical Training employer. If you are not currently on Optional Practical Training, please do not use this form.

Supplemental Repatriation and Medical Evacuation Insurance Enrollment Form

This form is used to enroll in supplemental medical evacuation/repatriation insurance.