Get J-1 Visiting Student Health Insurance Provider Certification Form

Filling out the J-1 Visiting Student Health Insurance Provider Certification Form is a crucial step for international students seeking to study in the U.S. This guide will provide you with clear and detailed instructions to help you complete this form efficiently and accurately online.

Follow the steps to successfully fill out the J-1 Visiting Student Health Insurance Provider Certification Form online:

1. Press the ‘Get Form’ button to access and open the J-1 Visiting Student Health Insurance Provider Certification Form in an editor.
2. Complete Section A of the form by entering your last name, first name, MIT ID number, and birthdate in the required format (mm/dd/yyyy).
3. Acknowledge your responsibility by reading the statement regarding health insurance requirements for J-1 visa holders. After understanding, proceed to sign and date the form.
4. If you have dependents, ensure you understand that your commitments regarding health insurance also extend to them; include any necessary information for dependent subscribers.
5. Move to Section B. This section must be filled out by the representative of your health insurance company. Provide their full name and write the insurance carrier name.
6. Fill in the member insurance ID number and indicate the coverage dates, ensuring they align with your MIT visit dates.
7. The insurance representative must verify that the policy meets the minimum coverage requirements by initialing each requirement listed.
8. Ensure the insurance representative provides their printed name, contact information (email and phone number), company name, title, and signature along with the date.
9. Once all sections are completed, review the form for accuracy. You can then save changes, download, print, or share the completed form as required.

Complete your J-1 Visiting Student Health Insurance Provider Certification Form online today!