Student Health Insurance

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All students attending Sierra Nevada College must provide proof of insurance before August 1, 2013. Students who fail to do so will be automatically billed for the SNC Annual Health Insurance Plan and will not be able to participate in off-campus school activities. Students who can provide proof of having equal or better health insurance coverage may waive out of the Annual Student Health Insurance Plan by copying both sides of the student’s insurance card and completing the both sides of the Student Health Insurance Waiver. A copy of the insurance card can be attached to this form. Legible photos of the insurance card will be sufficient, please feel free to use your cell phone to take photos of the front and back of your card, then attach the photos to this form

Students interested in SNC’s Annual Health Insurance Plan must check the yes box to enroll. Enrollment takes a minimum of two weeks, so please enroll before the start of classes to ensure your eligibility for participation in the student events. Once paperwork has been turned in and processed, students may attend any of the off campus school activities and sporting events.

Students living in the dorms will not receive roommate assignments until insurance information is provided. If you have any questions, please contact the Director of Student Affairs at: 775-831-1314, Ext. 7481

2012-13 Student Health Insurance Plan Information

Student ID*
Name*
FirstLast
Email*
You must use your Sierra Nevada email address (firstname_lastname@snceagles.sierranevada.edu). If you do not have one, sign up now.
Date of Birth*
Would you like the school's insurance plan?*
- Yes, I want the schools insurance plan
- No, I would like to waive the student insurance
2012-13 Student Health Insurance Plan Information
Local Mailing Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Insurance Waiver
Insurance Company*
Insurance Company Phone #*
Insurance Group #*
Insurance Subscriber ID#*
Subscriber’s Name*
Subscriber’s Relationship to You*
Attach a copy of your insurance card*
If you don’t have a scanner, try using a scanner app such as CamScanner from your smart phone or tablet to upload this document
Health Insurance Information
The following questions are required benefits and incorrect responses to these questions will result in waiver denial.

Please answer the following questions about your insurance coverage as accurately as possible
Does your plan provide primary care service?*
- Yes
- No
Does your plan provide emergency care service?*
- Yes
- No
Does your plan provide prescription drug coverage?*
- Yes
- No
If you answered ‘NO’ to any of the questions above, by signing and submitting this waiver form you accept full responsibility for any type of expenses associated with accidental fluid exposure that may occur in the clinical setting during your studies at Sierra Nevada College.
Notification/Signed Waiver Agreement
I am requesting to waive the Sierra Nevada College Student Health Insurance Plan. I certify that the information I have provided above is valid and accurate. I understand that if this information is found to be inaccurate, invalid, or does not meet the criteria for waiving out the Student Health Insurance Plan, I will be enrolled in the Student Insurance Plan and the appropriate fee will be billed to my student account.

I agree that I will maintain comparable health insurance at all times during this waiver period. If my health insurance is terminated for any reason, I will notify the Student Affairs Office immediately. I understand that a break in health insurance coverage may result in limited coverage for pre-existing medical conditions.

I agree to provide a copy of my health insurance identification card or other documentation as requested by the College, its agent or the Insurance Company. I understand that if I fail to provide documentation upon request, I will be enrolled in Student Health Insurance Plan and the appropriate fee will be billed to my student account.
Agreement*
- I verify that I have read all instructions and understand them.
Signature*

Don’t want to submit online?

Fill out the form, print the page, and mail to admissions.

Office of Admissions
Sierra Nevada College
999 Tahoe Boulevard
Incline Village, NV 89451

Insurance Waiver

Health Insurance Information

Notification/Signed Waiver Agreement

Don’t want to submit online?