All international students will be automatically enrolled in the Peralta Health Insurance Program through provider GeoBlue.

Upon enrollment, you will find an “International Student Health Insurance Fee” among other fees for tuition such as AC Transit, campus use fee, etc.
 
There are a limited number of reasons to waive this health insurance fee:
  • Students who receive health insurance from their US resident spouse or US resident parents.
  • Students who receive government sponsored health insurance from their home country.
  • Students who receive health insurance from their place of employment in the US.
  • Students who receive health insurance from their Non US resident spouse/parents, who are legally residing in the U.S.
  • Students participating in OPT

All waivers requests will be carefully reviewed, however, submitting a request for a waiver does not guarantee that your waiver will be approved.

The deadline to complete the Health Insurance Fee Waiver will correspond with the last day to drop regular session classes and receive a refund. Please confirm with Academic CalendarPlease note that students must apply every semester even if the fee waiver is approved in a previous semester. 

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* 1. What is your First name?

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* 2. What is your Last name?

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* 3. What is your country of citizenship?

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* 4. What Email address would you like to be contacted at?

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* 5. What Phone Number would you like to be contacted at?

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* 6. What campus is listed on your I-20?

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* 7. What is your Student ID number?

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* 8. Which semester/term are you applying for a waiver for?

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* 9. For which reason are you requesting a waiver from the health insurance fee

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* 10. Please upload all documents to support your waiver request which include documentation of your current health insurance plan and benefits.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 11. Please upload all documents to support your waiver request which include documentation of your current health insurance plan and benefits.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 12. Please share any other information regarding your request

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