Appeal or Qualifying Event Form

Loss of Health Insurance Coverage

If you have a loss of insurance coverage, please complete the form below and submit to the Student Health Insurance Office. You may email the form to sip@nullwfu.edu or drop off in Reynolda Hall 9A. Please call 336-758-4247 or email sip@nullwfu.edu for more information.

If a student is found to have no insurance or insurance that doesn’t meet our criteria (even after applying for waiver), he/she will be enrolled in the Student Blue plan through WFU.

Qualifying Event Form

Insurance Appeal Form

WFU-Appeal-Form