OSU Graduate Assistant / Associate
Declination Information

You have the right to decline the Health Insurance Plan provided to graduate assistants and associates.

To decline this coverage, please print and complete this declination form and return it to University Health Services. If you are having difficulties accessing or printing the form, a copy of this form can be obtained by either calling 744-7023 or by going to the UHS Insurance Office. This declination will remain in effect unless rescinded by written statement to University Health Services. If you choose to accept this coverage at a later date, your application would be subject to the same constraints regarding enrollment periods and eligibility.

This declination must be received within thirty (30) days of your initial eligibility date for it to become effective during the current semester. If received after thirty days, it will take effect at the beginning of the next eligibility period.