LaGrande HW - EIIA Member Portal

Please Read Before Beginning

LaGrange College requires all full-time registered students taking 12 or more credit hours to have active coverage in order to take classes.

Student Waiver Form

If you are insured individually or through one of your parents, you may elect to waive the insurance coverage offered by LaGrange College.

You must provide ALL of the necessary information below and answer the questions to successfully waive this coverage. Your primary insurance coverage must cover you throughout the entire academic year, and your coverage must exceed or be comparable to the benefits provided under the LaGrange College Student Health Insurance plan.

Please have the following information available:

● Student Information (including your student ID number)

● Policyholder’s information, if it is not you (name and telephone number)

● Insurance company information (name, phone number and ID number)

Waiver Criteria

It is required that your insurance cover:

● In-patient and out-patient medical care coverage in Georgia

●In-patient and out-patient mental health and substance abuse in Georgia

● Have pharmacy coverage

● Be active, and will cover you while you are within Georgia

Privacy Policy

The personally identifiable information that you provide through this secure website is made available only to authorized agents of your institution and EIIA for a period of one (1) year.

Important Information

After successfully waiving coverage, you will be unable to gain coverage through the LaGrange College insurance policy without a “Qualifying Life Event”. If you experience a Qualifying Life Event, you must notify EIIA at 888.255.4029 within 30 days of losing your coverage to be eligible for special enrollment.

If you need to change any previously submitted waiver information, please contact us for assistance by calling 888-255-4029 or texting 312-620-8902.
Agreement * Required
I have read the above information and wish to continue.
- Yes

Policy Holder and Insurance Information
Policy Holder Last Name: * Required
Policy Holder First Name: * Required
Insurance Company Name * Required
Please choose the best option for your carrier. For example, if you have Anthem BCBS Connecticut, please select Blue Cross & Blue Shield (BCBS). If you have Aetna Better Health, please select Aetna. If your carrier is not included please select ‘Other.’
Insurance Company Name: * Required
Your Insurance Company was not on the list, please type in the name of your carrier.
Insurance Company ID Number: * Required
Insurance Company Group Number:
Insurance Company Phone Number: * Required
Upload Insurance ID Card
Optional: Please provide a copy of the front of your insurance ID card. Doing so will help cut down on processing time if there are any questions or follow up is needed.
Accepted file types: jpg, pdf, png, Max. file size: 10 MB.
Maximum file size - 10 mega bytes.
Waiver Criteria

It is required that your insurance cover:

● In-patient and out-patient medical care coverage in Georgia

● In-patient and out-patient mental health and substance abuse in Georgia

● Have pharmacy coverage

● Be active, and will cover you while you are within Georgia

You are responsible for any payments needed such as co-pays and deductibles on your current health insurance that you are waiving with. Please check your plan to see what costs you may be responsible for.
My insurance will cover me while I am at LaGrange College * Required
- No
- Yes
It is required that your insurance cover you for Routine, non-emergency care, as well as emergency care while you are within the State of Georgia. It is likely that your waiver will not be approved.
I have Medicaid Coverage: * Required
- No
- Yes
Out of state Medicaid will not be accepted.
Are you an International Student? * Required
- No
- Yes
● Your insurance must have a U.S. Claims Address to be accepted
● Your plan must have coverage for pre-existing conditions, provide pharmacy coverage, and in and out patient coverage in your area
● It must provide at least $25,000 coverage for Repatriation & at least $50,000 coverage for Medical Evacuation (repatriation provides transportation to your home country in the event of death; medical evacuation is emergency transportation to the nearest, most qualified treatment facility)

Step 1 of 4

Please Read Before Beginning

Student Waiver Form

Waiver Criteria

Privacy Policy

Important Information

Student Information

Policy Holder and Insurance Information

Agreement