Student Health Insurance

[All information is subject to change without notice.]

Waiver Documentation Required for Students with UT Select Health Insurance

You are eligible for a waiver if you have been assessed the fee AND have elected UT Select through the Human Resources (HR) Office due to a UTD TA/RA appointment.

Provide a copy of one of the following types of documentation that verifies enrollment in the UT Select Health plan:

• The front and back of your UT Select health insurance card.
• The confirmation letter from the UT Touch System.
• A TA/RA Benefit Verification form signed and dated by a Human Resources (HR) office representative.  (The SHI Office has supplied personnel in your department with this form.  It is also available at UTD ISS - Electronic Forms

Instructions

1.  Print the online waiver form and complete it fully. Please be sure to sign the waiver form.

2.  Collect supporting documentation to verify that you meet the waiver eligibility criteria.  Photocopy or scan the documents.  See above for the list of acceptable documentation. 

Note: If you qualify for a waiver and your insurance plan does not include repatriation and medical evacuation coverage, you will be assessed this fee and enrolled in an approved repatriation and medical evacuation plan to comply with U. T. System regulations.

3.  Submit the signed waiver form and supporting documentation.  You may submit this information: 

• IN PERSON to the Student Health Insurance Office located within the International Student Services Office of the McDermott Library, room 1.310.You must bring photocopies.

• BY EMAIL from your @utdallas.edu address to issoinsurance@utdallas.edu. 

Important details concerning email submissions:

• You must submit your request using your @utdallas.edu address.  Requests from non-UTD addresses will not be processed.
• Your email must include attached scanned copies of the signed waiver form and the acceptable supporting documentation.
• You will receive an email from issoinsurance@utdallas.edu within 2 business days to verify that your request has been received and processed.  If you do not receive this email, your waiver request has not been processed.  Contact the SHI office at 972-883-4189 to inquire about the next steps.

• DO NOT SUBMIT YOUR WAIVER APPLICATION BY FAX.  This method of data transfer is unsecure, and your request will not be processed.