Prescott College Student Online Waiver

Please read before starting:

It is highly recommended that you review the FAQ and Help page so you know what information you will need to provide to complete and submit the waiver. Once you submit your Student ID and date of birth to view the waiver form, you will only have 15 minutes to complete and submit the waiver application. If you are not able to complete the waiver in that time you should close your web browser and come back to the on-line waiver once you have the information you need to complete it.

Before you begin, you need to be prepared to answer the following questions:

  1. Insurance Company Name
  2. Insurance Company Phone #
  3. Subscriber’s Name
  4. Insurance Subscriber/Medical ID #
  5. Subscriber's relationship to you
  6. Is your insurance plan owned, headquartered and operated in the United States?
  7. Does your plan provide access to Emergency Care within 25 mile radius of Prescott College?
  8. Does your plan provide access to Primary Physician Care and/or Urgent Care services within 25 mile radius of Prescott College?
  9. Does your plan pay for Preventative Services at 80% or more?
  10. What is your plan’s Annual deductible?

Please enter your Student ID number and date of birth below.

Insurance Waiver Login

This form must be submitted no later than -  1/18/2019 

Products and services are offered through USI Insurance Services National, Inc. a wholly owned subsidiary of USI Insurance Services LLC. Products and services are underwritten by unaffiliated insurance companies. Some services require additional fees and may be offered directly through third-party providers.