Student Insurance Waiver

All students will automatically be charged an insurance fee in both the fall and spring semesters if a waiver is not completed by the communicated deadline.

 

Student Insurance Waiver
Your plan must meet the following criteria to waive the student insurance.

Please note that coverage for emergency-only care in the Nashville, TN area does not satisfy the requirements to waive the student insurance.

  • The plan must provide in-patient care in the Nashville, TN area (including mental health care)
  • The plan must provide out-patient care in the Nashville, TN area (including office visits, out-patient mental health care and ancillary procedures).
  • The plan must be provided by a company licensed to do business in the United States, with a U.S. claims payment office and a U.S. phone number.
  • The individual (not family) deductible on the plan should not exceed $2,000 per policy year.
  • The plan must meet Federal Regulation Coverage requirements as outlined in the Patient Protection & Affordable Care Act of at least $100,000 in covered essential benefits per year.

Student Insurance Waiver Form

  • Please have an electronic copy of your insurance card (front and back) ready before completing this form.

  • Student Information

  • If your ID has not yet been assigned, please leave blank.
  • Insurance Plan Information

  • This section requests information about your current medical insurance plan.

  • Date Format: MM slash DD slash YYYY
  • Drop files here or
  • Confirmation of Insurance Requirements

  • Your plan must meet the following criteria to waive the student insurance.
    Please note that coverage for emergency-only care in the Nashville, TN area does not satisfy the requirements to waive the student insurance.

  • Attest & Acknowledge

  • By typing your legal name (first name MI last name) below, you acknowledge and agree to the following:

     

    * I attest that the information provided in this form is true and correct to my knowledge.

     

    * I acknowledge that I am responsible for payment of ALL FEES for medical and mental health treatment not covered by my health insurance plan (including but not limited to deductibles, copays, coinsurance and the expenses above my policy maximums and benefit limits). I understand that some health facilities, including Student Health Services, may require payment at the time treatment is provided.

     

    * I also acknowledge that if during the year, the statements I agreed to are found to be false, I will be added to the Meharry Medical College student insurance plan and will be responsible for the fee charged to my student account.