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Eastern Nazarene College
STUDENT HEALTH INSURANCE PLAN

Campus Undergraduate Student Waiver Form
2024-2025 Academic Year

An insurance plan whose coverage in the Quincy area is limited to treatment at an Urgent Care Center or an Emergency Room is not acceptable coverage.

Students with coverage through MassHealth Limited or the Children’s Medical Security Plan are not eligible to waive. Students with other types of MassHealth can waive if they can access their benefits near the campus.

Please note: most out-of-state Medicaid and HMO plans do not provide adequate coverage in Massachusetts. If you live outside of Massachusetts, it is highly recommended that you call member services for your insurance provider and ask about your coverage in this area before you waive the insurance.

International students must be insured by a plan that is filed and approved in the U.S. and is compliant with the ACA. Plans marketed to international students only do not meet this requirement.

TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:  
Student ID is 7 digits, including any leading zeros

Asterisk (*) denotes required field

STUDENT INFORMATION

 
 (MM/DD/YYYY)