ELON UNIVERSITY 2011-2012
INTERNATIONAL STUDENT INSURANCE WAIVER


Cutoff Date:
12:00 PM February 29, 2012

All full-time and part-time students enrolled in a college, university and other institutions of higher learning in Elon, NC must participate in a school sponsored health insurance plan, or another alternate plan with comparable coverage. Policy must include medical evaluation and repatriation of remains.

If you do not want to purchase the school sponsored insurance plan because you already have an alternate insurance plan comparable to the schools program, you must complete the waiver form before February 29, 2012.  If you do nothing, the school will automatically enroll you in the health plan and include the cost of the insurance in your tuition bill.  It is very important that you comply with this requirement in order to avoid a charge for the insurance in your tuition bill.

Students:  By completing this form, I certify that I have comparable coverage and that I have read and understand that I wish to waive the ELON UNIVERSITY insurance and NOT participate in the school insurance plan.

I fully understand that I am legally responsible for any medical expenses. It is also understood by me that if I lose my medical insurance protection, I will notify ELON UNIVERSITY and make necessary arrangements to join the University sponsored plan within 30 days. I release Elon University and Collegiate Risk Management from any direct responsibility beyond the conditions specified in the brochure.

I have determined that my insurance includes all benefits mandated by the Elon University Law. I have also determined that my insurance provides me access to health care providers in the area where my school is located.

This waiver is only effective for the 2011-2012 policy year.

Comparable Coverage:

  • Inpatient hospitalization (excluding surgery): Covers 80% of the actual expenses up to a maximum of $25,000.
  • Outpatient Services (excluding surgery): Covers 80% of the actual expenses up to a maximum of $1,500 per illness or accident.
  • Surgical Coverage (excluding surgery): Covers 80% of the actual expenses for the surgery performed inpatient or outpatient up to a maximum of $5,000.
  • Free Care does not meet the requirements for comparable coverage.

By pressing the submit button I am indicating my understanding and acceptance of the conditions of this insurance waiver.