University of Bridgeport
STUDENT HEALTH INSURANCE PLAN

New Summer Student Waiver Form
2023-2024 Academic Year

This form is for new summer students who are charged the summer premium only. 

You are electing to waive the student health insurance coverage provided by the University of Bridgeport. You understand that on the following page, you will be asked to enter your current health insurance information that meets or exceeds the minimum coverage requirements of the University of Bridgeport. 

PLEASE NOTE: INTERNATIONAL STUDENTS ARE NOT ABLE TO WAIVE THIS HEALTH INSURANCE. 

Helpful tips for completing your waiver:

• Please have your current health insurance ID card and a summary of your plan benefits available, as you will need this information to waive the plan. 
• Please make sure providers in Connecticut are in your insurance network. 
• If you are unable to accurately answer the questions on the online waiver form, please contact your insurance company for the necessary information. If your answers indicate that you do not have comparable insurance coverage, you will not have access to the waiver. 

Please allow 2-3 weeks for charges to be removed from your UB account. DO NOT call for verification that your information has been received. 

Any questions or concerns may be directed to info@univhealthplans.com or 833-251-1128. Please be sure to include your name and Student ID in your email. 

If you would like to waive the University of Bridgeport Student Health Insurance Plan, please continue and complete the following online waiver form. To access the form, enter your UB Student ID and date of birth below. Your UB ID is a 7-digit number. You may need to add a zero if your number is less than 7 digits.

If you do not know your UB student ID, please contact the Bursar's Office at UB 203-576-4568.