HTH > Group Enrollment Acceptance Agreement
University of Pittsburgh

This plan is designed for and open to international participants enrolled at University of Pittsburgh.
I hereby certify that as the proposed participant, I will be attending University of Pittsburgh in the current or immediately upcoming academic term. I further certify that I am a non-resident alien and not a resident of the United States of America and that I am actively engaged in international education activities in the current or immediate upcoming academic term. Further, I understand that a participant whose coverage under this policy lapses shall be subject to all policy exclusions as of any subsequent effective date. I understand that the Company will pay benefits for Pre-Existing Conditions.
 
Verification of visa and academic enrollment documentation may be required at the time of claim submission.