Creating the Extraordinary Student Experience

Important Forms

 

**Forms for 2017-18 will be available on this page beginning July 1, 2017.

If you wish to submit a petition to waive for 2017-18, you will need to wait until July 1, 2017** 

Notices:
  1. Students cannot submit petitions for a policy year that has already ended. The deadline to submit a Petition to Waive for any 2016-17 coverage period is August 14, 2017. 
  2. The policy year corresponds to the August-to-August academic year, not the calendar year. See dates here.
  3. If you experience a Qualifying Event and wish to modify an existing selection or waiver, submit the Coverage Status Change form within 31 days. Do not submit a Petition to Waive or Petition to Enroll.
  4. With the exception of Qualifying Events, an SHI Benefits Plan selection stays in effect until the end of the policy year -- assuming academic eligibility is maintained -- and students cannot modify or drop that selection term by term. For example, if a student selects the SHI Benefits Plan for autumn, they cannot waive it for spring/summer. 

Change forms:

  • 2016-17 Petition to Waive (USE IF: You are an International student who meets waiver criteria OR You are a domestic student who missed the Select/Waive deadline OR My Buckeye Link would not let you waive.) 
  • 2016-17 Coverage Status Change (USE IF: You wish to modify your existing selection or waiver due to a Qualifying Event. Note: Members called up to Active Duty should contact our office for assistance.)
  • 2016-17 Petition to Enroll (USE IF: You missed the Select/Waive deadline or have special academic circumstances.)

Interim forms (see eligibility requirements):

Member forms:

Documentation forms: