Graduate Student Health Insurance Waiver

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Health Insurance Waiver
Eligible graduate students who work 0.25 to 0.50 FTE (10-20 hours per week) and complete the required Certification of Eligibility for Graduate Insurance Form within enrollment will be considered for health insurance waiver.

Graduate students employed as Other Personnel Service (OPS) workers are not eligible for this coverage.  

Eligible Graduate Students:

  • Graduate Assistants
  • Teaching Assistants
  • Research Assistants

Application Requirements:

  1. Must work 0.25 to 0.50 FTE as a Graduate, Teaching, or Research Assistant.
  2. Must complete the Certification of Eligibility for Graduate Insurance Form each semester and have a valid contract to cover the period to be eligible for this coverage.
  3. The Form must be signed and dated by the student and supervisor.

Please follow the instructions listed below carefully:

1.   Prepare Recipient Information: Before clicking on the link to access the form, ensure you have gathered all the required information for the recipients. The recipients are individuals who need to sign or receive the document. This includes their full names and email addresses.

2.   Open the Form Link: Click on the provided Certification of Eligibility for Graduate Insurance Form.

3.   Enter Recipient Information: You will be prompted to enter the recipient information before proceeding with the form. This includes the full names and email addresses of all individuals who need to sign or receive a copy of the document.

4.   Specify Copy Recipient: Please fill out the required fields for you and/or someone else to receive a copy of the completed form.

5.   Fill Out the Form: Once recipient information is entered, click “Begin Signing” to start working on the form. Take your time to ensure all fields are completed accurately.

6.   Review Before Submission: Before submitting the form, carefully review all information entered. Ensure there are no errors or missing details.

7.   Sign and Submit: Sign the document electronically as indicated. Then, submit the completed form

8.   Confirmation: After submission, the form will be routed to your supervisor for signature, following the order in which recipients were entered. Once all required signatures are obtained, the form will be automatically sent to the School of Graduate Studies and Research Office for processing. You should receive a copy of the signed form and a confirmation email indicating that the form has been successfully completed (if you selected to have a copy sent to you)

For questions regarding filling out the form, please contact your department/college/school. If you experience any of the following while completing the electronic form, please contact the ITS Operations Analysis Team at (850) 412-6539:

  1. You are unable to open the link provided.
  2. You did not receive an email from DocuSign after initiating the process.
  3. It has been an extended period since you last received confirmation that your document has been received or processed. ITS Operations Analysis Team can assist in identifying any issues with the process and be able to resend the form to the recipient where the document appears to be stuck.


Application Deadlines:

  • Fall Semester – September 8

  • Spring Semester – January 20 (Forms for the Spring Semester will cover the Summer Semester of the same academic year)

Incomplete forms will not be considered, and forms will not be accepted after the application deadline. For more information, email: or call (850) 599-3505.

Please note that you will be charged for health insurance if you do not complete and submit the Certification of Eligibility for Graduate Insurance Form or waive the University plan by the appropriate deadline.

If you already have health insurance and want to waive the university plan, complete the online United HealthCare Online Insurance Waiver.

For information regarding the University’s Health Insurance, visit FAMU Health Services .