INTERNATIONAL STUDENT HEALTH INSURANCE AGREEMENT
AL
L international students studying in the United States must have a valid health insurance that covers
medical expenses in the U.S. Because medical cost in the U.S. is very expensive, it is important that you
have a health insurance in case of unexpected illness or injuries.
As F-1/M-1 international student, you must carry a valid health insurance while maintaining your visa status.
This includes while you are enrolled in classes, during a vacation quarter, AND during OPT (Optional Practical
Training).
C
lover Park Technical College offers the health insurance plan through LewerMark Student Medical
Insurance. The insurance premium for 2020-2021 is $365.13 per quarter (3 months) and the fee is charged
automatically upon registration.
N
ot all medical treatments/prescription drugs will be covered by this insurance. Please read carefully the
insurance documents provided to you at New Student Orientation and familiarize yourself with the insurance
plan. Please do not hesitate to contact us if you have any questions.
I
f you have your own health insurance coverage from your home country or through your family member’s
employer, the quarterly insurance fee may be waived ONLY IF your own insurance is comparable to the
insurance from the College. If you would like to request a waiver, please provide a proof of the comparable
coverage in English for evaluation.
Please check the box, sign and date below:
I
need the health insurance through CPTC and hereby authorize the College to release my personal
information to LewerMark for the purpose of insurance plan enrollment.
I have my own health insurance that is comparable to the insurance plan from CPTC. I will submit a proof
of my insurance.
I, (print your name) _____________________________, understand that all international students must carry
a valid health insurance while studying in the United States. I agree to pay the insurance fee each quarter, or
keep my own insurance valid, while I am enrolled, during a vacation quarter and while I’m engaging in OPT. I
also understand that, if my own insurance coverage is not comparable, I’m required to get the insurance
through the College. I further understand that it is my responsibility to keep my own insurance valid, renew it in
a timely manner and submit a proof of the new insurance coverage to the International Programs Office.
___________________________________________ _________________________
Signature Date
