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Waiver of Insurance and Certification of Health Insurance Coverage for International Temple University Students

Temple University requires that all International (F1 and J1 visa status) students maintain adequate health insurance coverage at all times while a Temple University student. Health Insurance is available through Temple University and is administered by Independence Blue Cross. The minimum health insurance coverage as determined by the Department of State is:

Certification of Health Insurance Coverage

I hereby waive my opportunity to participate in the Temple University Student Health Insurance Plan. I also certify that I have coverage by an adequate outside health insurance under the policy noted below.

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If you do not have a Social Security Number, please enter your Temple ID Number (TUID) in the above field.

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Married
Single

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Spouse
Parent
Guardian
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Requirement

*Should this outside coverage cease for any reason, I will immediately obtain other adequate outside health insurance, or enroll in the Temple University Student Health Insurance Plan.*

By clicking on the submit button below, you are representing that you understand and agree to abide by this requirement. Failure to do so would constitute a violation of Temple University policy. By submitting this form, you are representing that all of the information above is true and correct. You understand and acknowledge that the submission of false information to Temple University is a violation of its student Code of Conduct and may subject you to discipline up to and including expulsion from Temple University.


* I accept these terms. « Required


You will receive a copy of this application via email.