Request a waiver from the domestic health insurance available through UB for students who meet the special circumstance criteria.
If you did not yet read the informational insurance information, please do that before completing and submitting this form.
You will only be permitted a waiver of the cost of the SUNY health insurance if your policy matches or exceeds the policy available through SUNY, and is approved by UB’s Student Health Insurance Office. In some cases, your policy must also match or exceed requirements from the U.S. Department of State (policies that meet SUNY requirements typically meet these requirements; the UHCSR plan available through SUNY far exceeds that U.S. Department of State requirements).
This form is not currently available online. Please contact the Health Insurance Office to request this form.
* 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.
Student Health Insurance Office
Student Life
1 Capen
University at Buffalo
Buffalo, NY 14260-2100
Phone: (716) 645-3036
