SUNY Buffalo State 2017-18's Online Waiver

Student Information

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 I DECLINE the Student Health Insurance Plan and hereby apply for a waiver. I have read the description of the student health insurance plan provided to students of Buffalo State College. It is my judgement that I have comparable coverage and I am therefore choosing to waive this plan. I acknowledge that I am legally responsible for any medical expenses incurred during my enrollment and that Buffalo State College will not be responsible for any of my medical expenses.

I DECLINE the Student Health Insurance Plan and hereby apply for a waiver. I have read the description of the student health insurance plan provided to students of Buffalo State College. It is my judgement that I have comparable coverage and I am therefore choosing to waive this plan. I acknowledge that I am legally responsible for any medical expenses incurred during my enrollment and that Buffalo State College will not be responsible for any of my medical expenses.

Please provide the following information about your current medical insurance:



Insurance Company Information



If your insurance company is not in the drop-down list, enter it below.

Please answer the following about the Insurance Subscriber (primary insured):


Please answer the following if your coverage is provided by employer sponsored plan: