International Health Insurance Dependent Enrollment Form

Enroll your dependents in health insurance offered through SUNY. This form is for dependents of international students and scholars, and dependents of faculty/staff going abroad

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

You can only enroll your dependents after you have been enrolled in SUNY health insurance by the Student Health Insurance Office.


* 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