International Health Waiver

All international students at the University of Tennessee at Chattanooga must obtain health insurance to be protected against any potential health care costs while studying at UTC.

Information for International Students who select the alternative health insurance:

1) International students may request to waive the cost of the UTC student health insurance if they have obtained other insurance coverage before waiver request deadlines.

2) The purchased insurance must meet the university mandated health coverage criteria as stated below.

3) The health insurance waiver requirements, the deadline for waiver requests, and required coverage periods are stated on the waiver form.

4) Students requesting a waiver of UTC health insurance should read the completed waiver request form in its entirety, follow the directions accurately and submit the information before the deadline.

Health Insurance Waiver Request Form

Your Family Name (Last Name) *

Student Email (please use a personal email like Gmail, Yahoo, etc. We would prefer one you used to apply to UTC if possible) *

Current Academic Level *

Please select the option that best describes your situation for the upcoming term: *

Please select EVERY value that your insurance covers below. To be eligible for the waiver, you must submit proof of insurance meeting all of the following checklist requirements. *

Unlimited Medical Coverage (MUST include preventative and emergency care)

Coverage for pregnancy cannot be excluded

Deductible not to exceed $500 per accident/illness

Repatriation coverage of at least $20,000

Medical evacuation coverage of at least $50,000

A waiting period for pre-existing conditions of less than 13 months

Requires student to pay less than 25% per accident/illness

A.M. Best Rating of "A-" or better or Standard and Poors rating of "A+" or better

All information must be provided in English and US dollars

Coverage period is dated as required

Insurance Company Name *

Coverage Start Date *

Please attach the proof of insurance card and policy.

Drop file here to upload

Allowed Extensions: .doc;.docx;.txt;.rtf;.pdf;.zip;.rar;.png;.jpg;.bmp;.jpeg

I have compared the UTC insurance policy with this policy and understand the differences between the two policies.

I understand that these are mandatory coverage periods in which continuous insurance coverage MUST be maintained.

I have attached proof of insurance (e.g. a copy of your insurance card) as well as a copy of my insurance policy/brochure to this form.

I agree to purchase and maintain insurance throughout the school year and understands all non-immigrant international students must have uninterrupted insurance while at The University of Tennessee at Chattanooga

I understand that the university does not provide informational or claims assistance for any insurance other than the UTC sponsored student health insurance.

I understand that UTC's approvals of this waiver is not an endorsement of the alternate insurance policy.

I understand that WAIVERS ARE APPROVED ON A SEMESTER-BY-SEMESTER BASIS AND MAY BE DENIED IN THE FUTURE.

I have read, understand and agree the 7 items above. *

Please type your name below as proof of understanding and agreement. *