Southwestern University Enrollment and Waiver Form

Southwestern University Waive or Enroll

Southwestern University requires all full time students to have active coverage in order to take classes. If you have active insurance that meets Southwestern University's requirements you may WAIVE off of the insurance coverage, otherwise you must ENROLL in the Southwestern University Student Health Insurance Plan.

If you are part time do NOT enroll or waive as you are not eligible.
Would you like to Waiver or Enroll? * Required
- Enroll in Southwestern University's Student Health Insurance Plan
- Waive (decline) Insurance offered by Southwestern University because you already have insurance that meets the required criteria

Please Read Before Beginning

If you wish to enroll in the Hard Waiver Accident & Sickness Plan, please complete the following information. Only Full-Time students are eligible to enroll.

Note: Once coverage is in place and you are insured for 31 days or you incur a medical claim, coverage may not be terminated.

If you previously waived this plan because you were insured but were involuntarily dropped by your insurance carrier, you may apply for enrollment by completing the information below. Active enrollment in the plan may take up to 48 hours from the receipt of the enrollment application.

If you have questions, please call us at 888-255-4029 or text 312-620-8902.
Full-Time Status * Required
- I am registered as a full-time student
Only students registered as full-time may enroll in the Southwestern University Student Insurance Plan
Agreement * Required
I have read the above information and wish to continue.
- Yes
Please Read Before Beginning

Student Waiver Form

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

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 Southwestern University 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 Texas

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

● Have pharmacy coverage

● Be active, and will cover you while you are within Georgetown, Texas (or local area where you will be residing and studying for the academic year)

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 Southwestern University 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

Step 1 of 3

Southwestern University Waive or Enroll

Please Read Before Beginning

Please Read Before Beginning

Student Waiver Form

Waiver Criteria

Privacy Policy

Important Information

Student Information

Policy Holder and Insurance Information

Agreement