As a student*, I acknowledge that I have read the following information and understand the insurance coverage offered by Champlain College through Wellfleet Group, LLC. I wish to submit my waiver to DECLINE the medical insurance offered for the 2023-24 Annual Term. Insurance will remain in effect for full-time students through 8/19/2024 unless a student withdraws from Champlain College or submits a waiver. The deadline to waive is January 24, 2024.

The Champlain College Student Health Insurance is an ACA (Affordable Care Act) compliant Gold Level Plan and has an unlimited maximum on all covered Essential Health Benefits. NOTE: Be advised that you may be eligible for coverage under a group health plan of a parent’s employer or under a parent’s individual health insurance policy if you are under the age of 26. If you have any questions or concerns about this notice, contact the plan administrator of the parent’s plan for more information.

Please review these materials carefully (with your parents or guardians, if applicable) to ensure you understand coverages provided and not provided. In addition, coverage under this secondary plan applies only after primary insurance, unless no primary insurance exists.

*All registered full-time traditional undergraduate (12 credits or more) will automatically be enrolled and billed for student health insurance offered by Champlain College through Wellfleet Group, LLC unless the student completes this online waiver by January 24, 2024. Master’s of Fine Arts students may request student health insurance by contacting the Office of Student Accounts.