Spring 26 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 your Student Self Services when the hold is released pending the final outcome of the option you choose below. These rates listed below are subject to final approval from the Department of Insurance

You must be in full compliance no later than January 12, 2026 (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 2025-2026 academic year (effective 01/01/26 to 8/16/26). Please select one of the options listed.

I will pay $2,197 for Spring/Summer coverage (effective January 1,2026 - August 16, 2026) prior to Monday, January 12, 2026 via Student Self Services. NOTE: tuition deferments does NOT include the health insurance premiumI will be Department Sponsored and understand that I will be held responsible for the annual premium of $2,197 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/Summer 2025 semester. I understand that I will be held responsible for the annual premium of $2,197 pending validation of my employment status from USF Human Resources.

Select Sponsoring Department

To be eligible for the Spring/Summer 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, work a minimum of 10 hours a week (.25 FTE of higher) and maintain eligibility throughout the semester.

I understand the following next steps:*

(1) I must successfully complete the pre-boarding process and received job offer letter. (2) Monitor your emailsstarting on November 15, 2025, for an email from info4students@mycare26.com. It will be sent 3-5 days after this form is submitted. (3) Click on the link in the email to activate account and enroll for the GA/RA/TA Subsidy program by January 12, 2026. (Currently enrolled in the 25-26 policy? Skip steps 1-3 and log back into your mycare26 account to enroll for 25/26 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 2025-2026 academic year (01/01/26-8/16/26). I understand that I must maintain continuous coverage and held responsible for the annual premium of $2,197 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, 2025 and January 12, 2026*

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 Services account is updated and the premium fee removed.

Waiver/Opting out documents submission dates is from November 15, 2025 to January 12, 2026 and I understand the following:*

If I miss the final deadline of January 12, 2026, 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

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

I agree.