Study Abroad Health Insurance Dependent Enrollment Form

Enroll your dependents in health insurance through SUNY if you’re participating in a study abroad or exchange program, going abroad for university-related programs, or if you’re a faculty or staff member going abroad.

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

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.

To Submit this Form, or Get Help

1 Capen
University at Buffalo
Buffalo, NY 14260-2100

Phone: (716) 645-3036