This form is designed to assist students in complying with the Virginia Commonwealth University School of Medicine policy (refer to the Student Handbook), which mandates that all medical students shall have and maintain health insurance coverage. The Compliance Form sets forth the minimum insurance requirements for all enrolled (including newly enrolled) medical students. Students must verify that the basic benefits outlined in the form are included in their health insurance policy and provide documentation that their policy offers those benefits necessary to meet the established requirements. If any of these benefits are not covered, a hold will be placed on the student's account (registration) until proof of sufficient coverage is received in this office. This hold means that you cannot attend classes or participate in clinical activities, and you will not be eligible to receive financial aid. Please allow at least 6-8 weeks processing time to confirm receipt. Submission deadlines are as follows:

M1 students (new enrollees): 0719/19
M2, M3 & M4 students: 08/31/19


1. Please contact your insurance company and speak with an agent/representative to review and assist in the completion of section II of this form. In order for a policy to be considered compliant, the questions contained on the form should receive a response of "Yes".

2. Please request a Certificate of Group and/or Individual Health Plan Coverage from your insurance agent/representative. The Certificate should be submitted as part of section III of this form. The certificate should contain the following information:

a. Date of the Certificate

b. Name of Health Plan

c. Name of the Participant

d. Identification Number of the Participant

e. Name(s) of the Covered Dependent(s) to whom this Certificate applies

f. Plan Administrator (include name, address and telephone number)

g. Date Waiting Period (if any) began

h. Date Coverage began

i. Date Coverage will end

3. A health Insurance card WILL NOT BE CONSIDERED an acceptable form of Proof of Health Care Coverage.

If you have any additional questions or need assistance with regard to this compliance policy, please contact the VCU School of Medicine Student Affairs Office at (804) 827‐1260 or via email at

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