HTH > Group Enrollment Acceptance Agreement

University of Michigan - Leisure Travel

This plan is designed for Leisure Travel for participants enrolled at University of Michigan only.

I hereby certify that as the proposed UM HTH travel health insurance participant, I am affiliated with the University of Michigan for the current or immediately upcoming school year and meet the University of Michigan criteria to purchase this plan as listed on www.uhs.umich.edu/tai.

All my covered Dependents: spouses/ unmarried domestic partners of any gender, or other qualified adults and children must be traveling with me while that dependent is engaged in international travel.

I understand that as a UM HTH travel health insurance participant, whose coverage or eligibility under this policy lapses, I shall be subject to all policy exclusions including termination of the plan and withdrawal of payment for claims. Verification of visa status, UM eligibility to purchase the plan, UM employment and/or UM academic enrollment documentation may be required at the time of claim submission.