International Health Insurance Enrollment Form

Enroll in international health insurance offered through SUNY as an international scholar, OPT or faculty/staff member.

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

This form is for international scholars, OPT and faculty/staff who are enrolling in International Student Health Insurance. Registered international students do not need to fill in an enrollment form, since they are automatically enrolled after they are billed for the coverage.

Print the Form

Step 1

Step 2

Two to three business days after submitting this form, please check your email for:

  • confirmation of enrollment
  • balance due (insurance charges)
  • E-Pay link for submitting your on line payment

Accessibility

* 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; Fax: (716) 645-3948