Skip to main content Skip to main menu

Indiana University
Graduate Fellows, Student Academic Appointees & Appointed Post-Doctoral Fellows

Waiver Form
2024-2025 Academic Year

If you have a health insurance policy that provides comprehensive benefits near the campus at the start of the term, you can use this form to opt out of the IU Plan.

TO CONTINUE THE WAIVER PROCESS, PLEASE FILL OUT THE REQUIRED FIELDS BELOW:

Asterisk (*) denotes required field

 (MM/DD/YYYY)