Health Insurance Waiver Form Submission and Agreement

While studying at Hawai‘i Pacific University (HPU), students need to protect their health and financial stability by having adequate health coverage to address minor and major illnesses that may arise, and to avoid unexpected interruption of their education by high medical expenses. Furthermore, all J-1 scholars and their J-2 dependents are required to maintain health insurance coverage that meets U.S. Department of State requirements for their program.

HPU believes that a health insurance policy best satisfies these requirements for our international students. As such, international students are required to have health insurance as a condition of enrollment at the University. To ensure all international students timely meet this requirement, students will be charged a $100 medical insurance late fee if not complete and submitted before or on the 2-week deadline. To avoid this late fee, students should complete and submit the forms below at least 2-weeks before the first day of the semester. In any event, all students shall remain responsible for securing health insurance that meets HPU’s minimum coverage requirements.

What is your name? What is your name? First Last
HPU Student ID Number

@ sign is not required
HPU Student Email Address
I understand that the Health Insurance Waiver Form is required for international students by Hawaii Pacific University.
(Link: Health Insurance Waiver Form)

I understand that the Health Insurance Waiver Form is required for international students by Hawaii Pacific University. (Link: I understand

Or copy and paste to access form:

https://www.hpu.edu/oiss/files/hiw_spring2024
I confirm that the due date for the Health Insurance Waiver Form is 2-weeks before the semester start date. I acknowledge the semester start date per the Academic Calendar.

I confirm that the due date for the Health Insurance Waiver Form is 2-weeks before the semester start date. I acknowledge the semester start date per the Academic Calendar. I understand

Or copy and paste link to access calendar:

https://www.hpu.edu/registrar/academic-calendar.html
I understand that the Health Insurance Waiver Form is required to be submitted every semester or year based on my health insurance policy. I acknowledge to check my policy for accurate dates in line with the school year.

I understand that the Health Insurance Waiver Form is required to be submitted every semester or year based on my health insurance policy. I acknowledge to check my policy for accurate dates in line with the school year. I understand
I acknowledge that I must be enrolled in coverage for the duration of the semester (August - December / January - May) or year (August - May).

I understand that failure to have coverage or incorrect coverage dates will result in a $100 fee.

I acknowledge that I must be enrolled in coverage for the duration of the semester (August - December / January - May) or year (August - May). I understand that failure to have coverage or incorrect coverage dates will result in a $100 fee. I understand
I understand that it is up to me, as the student, to accurately complete the Health Insurance Waiver Form. I understand that if the form is turned in late, incomplete, or inaccurate/incorrect, then I am subject to a $100 late fee charge onto my student account.

(Example: Health Insurance Waiver Form Example>)

I understand that it is up to me, as the student, to accurately complete the Health Insurance Waiver Form. I understand that if the form is turned in late, incomplete, or inaccurate/incorrect, then I am subject to a $100 late fee charge onto my student account. (Example: Health Insurance Waiver Form Example>) I understand

Check your form!

Copy and paste for a completed Health Insurance Waiver Form example:

https://www.hpu.edu/oiss/files/hiw_example_form

Date of Submission Date of Submission / MM / DD YYYY

Upload your Health Insurance Waiver Form here

(accepted file types: jpg, jpeg, png, pdf, docx, doc, zip)