Montclair State University
STUDENT HEALTH INSURANCE PLAN

International Student Waiver Form
2024-2025 Academic Year

Montclair requires all international students to be insured with a plan that is filed and approved in the U.S., compliant with the ACA, and provides no limit on Essential Health Benefits. Please note, health insurance plans marketed solely to international students are often not filed and approved in the U.S. and have limited benefits, provider networks, and/or coverage periods that do not comply with the Montclair insurance requirements. GBG Insurance, HDL Global Specialty, ISO, PGH (United), PSI, Student Medicover, and Tata AIG are examples of companies that do not meet the waiver requirements.

In general, the only plans that meet the waiver requirements for international students are Embassy-Sponsored Plans, US Employer-Sponsored Plans, or US Health Insurance Marketplace Plans.

You may waive coverage under this plan if you have health insurance that meets all of Montclair State University’s insurance plan requirements. You will need to provide information about your coverage. An accepted waiver applies to the full academic year during which it is filed.

The waiver deadline is September 16, 2024.

PLEASE FILL OUT THE REQUIRED FIELDS BELOW:

Please note, your Montclair State University student ID# begins with an "M" followed by 8 digits. You must include the UPPERCASE "M" in your student ID number when entering it below.

Student Health Plan

Benefit Information