Domestic Student Health Insurance Enrollment Form

Enroll in health insurance through UB as a domestic student (full-time or part-time). 

If you did not yet read the informational insurance information, please do that before completing and submitting this form.

Full-time students are automatically enrolled in health insurance through UB, unless they have an approved waiver on file. You can also proactively enroll yourself by going to the Haylor, Freyer, and Coon, Inc. website.


* The University at Buffalo is committed to ensuring equal access to information that is presented online. As part of this commitment, university web content must be accessible to everyone, including individuals with physical, sensory, or cognitive impairments, with or without the use of assistive technology. If you encounter an accessibility issue when completing this form, please contact the health insurance office.

To Submit this Form, or Get Help

For help understanding and navigating the health insurance process.

1 Capen
University at Buffalo
Buffalo, NY 14260-2100

Phone: (716) 645-3036