GA/TA Health Insurance Waiver

Request a waiver for the premium refund if your policy matches or exceeds the UB-sponsored policy.

If you did not yet read the informational insurance information, please do that before completing and submitting this form.

Request a Waiver

International Insurance: request a waiver
  1. Click the link above or visit the Haylor, Freyer & Coon website where you will complete your waiver. Haylor, Freyer & Coon is the SUNY insurance broker who handles the waiver process.
  2. Login with your last name and UB person number. All fields are required.
  3. Name of GA/TA health insurance company: Blue Cross Blue Shield-Empire
  4. Address: P.O. Box 2300 Kingston, NY 12402
  5. Enter UB Person Number as Member ID
  6. If you do not have your insurance card yet, upload proof of your insurance. 

Accessibility

* The University at Buffalo is committed to ensuring equal access to information that is presented online. As part of this commitment, university web content must be accessible to everyone, including individuals with physical, sensory, or cognitive impairments, with or without the use of assistive technology. If you encounter an accessibility issue when completing this form, please contact the health insurance office.

For the best experience use a non-mobile device.

Check Your UB Email

It is your responsibility to check your UB email. If you request a waiver and it is denied, your notification will arrive via email. In addition, the University no longer generates a paper tuition statement. Your Student Account Statement is by eBill only. Failure to view your eBill details will not be accepted as a reason to waive the insurance charge after the published deadline.

To Get Help

If your HUB student account has been billed the Student Health Insurance premium and you do not meet the criteria for the requirement, please email Haylor, Freyer and Coon for a special circumstance opt-out option. This form is ONLY available to students who qualify due to part-time hours or online (remote) only learning.

Haylor, Freyer and Coon, Inc.

Phone: 866-535-0456

Email: student@haylor.com