International Health Insurance Dependent Medical Evacuation and Repatriation Enrollment Form

Enroll your dependents in medical evacuation and repatriation health insurance available through SUNY as an international student.

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

Medical evacuation and repatriation insurance is included in your SUNY health insurance. You do not have to enroll in separate medical evacuation and repatriation insurance if you are enrolled in SUNY health insurance.

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

1 Capen
University at Buffalo
Buffalo, NY 14260-2100

Phone: (716) 645-3036; Fax: (716) 645-3948