Drury University

International Support Services

Overview
• About the Office
• Staff
• ISA

Immigration
• Change of Address
• Comparison of F-1 and J-1
• Employment
• Maintaining F-1 Status
• Special Registration
• SEVIS
• SEVIS I-901 Fee
• Taxes
• Travel

Employment
• On-campus
• CPT (internship)
• OPT
• H1-B

Health Insurance
• Brochure (pdf)
• File a claim
• Waiver Petition

Related Links:
• English for Academic Purposes
• International Admission
• Student Affairs
• Academics
• Speaker’s Corner
• DU Calendar

Contact:
Jan Swann, Director
FSC 113
Office: (417) 873-7885
Fax: (417) 873-7860
jswann@drury.edu

Insurance Waiver Petition

2007-08 Academic Year

Full Name:

E-mail Address:

I do not wish to purchase the Drury University International Student Health Plan for 2007-08. In submitting this insurance Waiver Petition form, I fully understand that it is my responsibility to maintain health insurance for myself and my family (if applicable).

Answer YES or NO to each of the following statements about your health insurance plan:

Yes No	My plan is currently in force and will remain in force until July 1, 2008 (or beyond). For students graduating December 15, 2007: My plan is currently in force and will remain in force until December 31, 2007 (or beyond). Further, I understand that if this Waiver Petition is accepted by Drury University, I/my insurance company may be contacted to confirm continuous coverage on a periodic basis.
Yes No	My plan is a major medical health plan covering me and my family, in or out of the hospital. (No "hospital only" or "hospital confinement only" will be accepted.)
Yes No	My plan provides a minimum of $250,000 reimbursement per illness or accident for each insured person.
Yes No	I request waiver of the Drury University International Student Health Insurance Plan for 2007-08 because of a Pre-existing Condition.

Please check all that apply:

	My plan includes repatriation of remains coverage of at least $25,000.
	My plan includes medical evacuation coverage of at least $25,000.
	My plan is underwritten by a company licensed to do business in the United States.
	My plan is administered by an insurance company with a licensed claims office in the United States.

NOTE:

By submitting this insurance Waiver Petition form, I am agreeing that I do not wish to purchase the Drury University International Student Health Plan for 2007-08.

Also, I fully understand that it is my responsibility to maintain health insurance for myself and my family (if applicable).

Finally, I understand that granting this Waiver is in the sole and final discretion of the Drury University. If the Waiver is granted, I agree release Drury University from any liability for any issue of medical coverage.

If you do agree to the above statement, please select the "I Agree" button and you should receive an online verification that your application has been received.

A photocopy of your insurance card (front and back) and a copy of the declarations page (listing your benefits) from your current insurance policy must be submitted to the International Student Office (FSC 112/113) to complete your insurance waiver petition.