Student Billing

Waiver only honored if submitted before 9/15/14

Student Health Insurance Waiver

Name:  
Student ID Number: (e.g. 000-12345)  
Email Address:  
Home Phone Number:  
Cell Phone Number:  
Current Health Insurance Co. Name:  
Insurance Co. Phone Number:  
Insurance Policy/ID Number:  
Name of Policy Holder:          
 
Permission:
I give Alvernia University permission to contact the above listed health insurance carrier to confirm my enrollment.  I understand it is my responsiblity to contact the Student Billing office at student.billing@alvernia.edu if I become uninsured.
 
Please Initial:  
Please check below:
I am enrolled in the above health insurance and am waiving Alvernia's student health insurance.
Yes No


You will receive a confirmation to the above email address.  Please keep this for your records.  It could take up to 3 business days to reverse charges.  

     

Icon: CalendarStudent Billing Office

Alvernia University
Francis Hall Room 201
400 Saint Bernardine Street
Reading, PA 19607
Phone: 610.796.8319
Fax: 610.796.8425
eMail: Student.Billing@alvernia.edu

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Fall/Winter/Spring
Mid-August to May
Monday-Thurs. 8:00 a.m.-5:30 p.m.
Friday 8:00 a.m.-4:30 p.m.

Summer
June to Mid-August
Monday-Friday 8:00 a.m.-4:30 p.m.