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Emerson College
STUDENT HEALTH INSURANCE PLAN

Undergraduate Student Waiver Form
2024-2025 Academic Year

Domestic students with comparable coverage may submit a waiver form to opt-out of the student insurance plan. Once submitted, it will take approximately 5 business days for the adjustment to be made to your student account at Emerson College. 

If the student is a minor, then the parent or guardian must complete this form.

The Emerson Student ID begins with E and is followed by 8 digits.

Asterisk (*) denotes required field

STUDENT INFORMATION

 
 (MM/DD/YYYY)