If you are currently enrolled in the Fairfield University Student Health Plan for the 2015-16 policy year and you wish to waive the policy, please follow these instructions.

The deadline for the Petition to Waive is Monday, November 16, 2015

How to complete a Petition to Waive

If you wish to submit a Petition to Waive the Student Health Insurance, please follow these instructions to complete the online form (Current coverage must be comparable to the Student Health Insurance Plan.)


1.  Go to

2.  On the left toolbar, click "Petition to Waive"

3.  Log in to your account or create a new account if you are a first-time user

4.  Follow the instructions to cmplete the online Petition to Waive form

5.  Print or write down your reference number.  (Receipt of this number only confirms submission, not acceptance, of your form.)

6.  You should receive notification of your approval or denial within 7-10 business days.


Questions? Contact Gallagher Student at 1-800-397-2874, visit the website at or e-mail at

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