Spring 2025 Insurance Agreement

The international health insurance mandate must be fulfilled by international students (all visa types) on an annual basis at the start of the academic year. Therefore, annually all international students are automatically placed on a SI hold. To permit registration you must complete/submit this form to release the automatic SI hold.

Please note: The USF Sponsored Student health insurance (SHIP) premium will automatically post to Student Self Service when the hold is released pending the final outcome of the option you choose below.

You must be in full compliance no later than January 13, 2025 (specifics are listed by the option selected).

Student ID Number*

Please include U before the number

Full Name*

First NameLast Name

Birth Date*

MonthDayYear

E-mail*

Phone Number*

Area CodePhone Number

To release SI hold, select applicable button:*

Enrolling in USF Sponsored SHIPWaiving/Opting out of USF Sponsored SHIP with an Alternate health insurance plan

I am electing the USF Sponsored SHIP underwritten by Aetna Student Health for the 2024-2025 academic year (effective 01/01/25 to 08/16/25). Please select one of the options listed.

I will pay $2,056 for Spring/Summer coverage (effective Januray 1,2025 - August 16, 2025) prior to Monday, January 13, 2025 via Student Self Service.I will be Department Sponsored and understand that I will be held responsible for the Spring/Summer premium of $2,056 pending validation of my status from the department I select below.I will be eligible for the Graduate Insurance Subsidy, as an employed GA/RA/TA for the Spring semester. I understand that I will be held responsible for the Spring/Summer premium of $2,056 pending validation of my employment status from USF Human Resources.

Select Sponsoring Department

To be eligible for the Fall GA insurance subsidy program, I understand that I must meet the following:*

Be an active employee in the USF employment system in one of the following job codes: 9181, 9182, 9183, 9184, 9185, or 9550 and work a minimum of 10 hours a week (.25 FTE of higher)

I understand the following next steps:*

(1) I must successfully complete RightStart. (2) Allow 5-10 days for an activation invite email from info4students@mycare26.com (3) Click on the link in the email to activate account and enroll for the GA/RA/TA Subsidy program by January 17, 2025. (Currently enrolled in the Fall 24 policy? Skip steps 1-3 and log back into your mycare26 account to enroll for 24/25 SHIP and/or reset password if forgotten.)

I am electing to waive/opt out of the USF Sponsored SHIP and will provide proof of an adequate alternative health insurance policy for the 2024-2025 academic year (01/01/25-8/16/25). I understand that I must maintain continuous coverage and held responsible for the Spring/Summer premium of $2,056 until alternative coverage is validated.

I will provide proof of an alternative health insurance policy purchased by me and/or family member.I am a Sponsored/Funded International Student and will provide proof of my enrollment in an alternative health insurance policy provided by a NON-USF Organization.I have DACA Status and I will supply my current Notice of Action I-797.

Select Visa status to review next steps. You must upload proof of your alternative policy to Academic Health Plans (AHP) student portal, Care26.com between November 15, 2024 and January 13, 2025*

F/J visa holder: (1) Monitor your emails starting on November 15th for an email from info4students@mycare26.com. It will be sent 3-5 days after this form is submitted. Click on the link provided to activate your Care26.com account. Already have a Care26.com account? Just log in or reset password if forgotten. (2) Have your health insurance company complete the USF Insurance Compliance form and upload it to your Care26.com account with a copy of the front and back of your insurance card. (3) Allow 2-3 weeks for review/determination. Both AHP and USF must approve your policy before your Student Self Service account is updated and the premium fee removed. Remember, returning students cannot have a gap in coverage.non-F/J visa holder: (1) Monitor your emails starting on November 15th for an email from info4students@mycare26.com. It will be sent 3-5 days after this form is submitted. Click on the link provided to activate your Care26.com account. Already have a Care26.com account? Just log in or reset password if forgotten. (2) Upload a copy of the front and back of your insurance card. (3) Allow 2-3 weeks for review/determination. Both AHP and USF must approve your policy before your Student Self Service account is updated and the premium fee removed.

Waiver/Opting out documents submission dates is from November 15, 2024 to January 13, 2025 and I understand the following:*

If I miss the final deadline of January 13, 2025, I will be required to purchase/enroll annually for USF Sponsored SHIP.

I understand that I will need to provide my current Financial Guarantee or Scholarship award letter, as well as a copy of the front and back of my health insurance card. I will select my sponsoring organization from the menu below.

Upload Supporting Documentation

Browse Files

By checking the box below, I acknowledge that I have read and reviewed the information above for the option I selected.*

I agree.