Reinstatement Form

This form is for students who had formerly waived out of the CampusCare program and now wish to be reinstated.

New Dependents may be added to the CampusCare program provided required documentation is received in our office within 31 days of newborn birth (Birth Certificate) or new marriage (Marriage Certificate). Please refer to the Dependent Coverage section on our FAQ pages for eligibility requirements.

For more answers on frequently asked questions about this form, please see the Waiving & Reinstating Coverage section on our FAQ pages.

Other Available Forms Waiver Form Dependent Enrollment Form Dependent Disenrollment Form