This form is designed to assist students in complying with the Virginia Commonwealth University School of Medicine policy, which mandates that all medical students shall have and maintain health insurance coverage. The policy sets forth the minimum insurance requirements for all 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 provides 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. This form should be submitted by July 19th, 2020. Please allow at least 4-8 weeks processing time to confirm receipt.


1) Please contact your insurance company and speak with an agent/representative to review and assist in the completion of the 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 Coverage from your insurance agent/representative. The certificate should be submitted with the form. The certificate should contain the following information:

  1. Date of the Certificate

  2. Name of Health Plan

  3. Name of the Participant

  4. Identification Number of the Participant

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

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

  7. Date Waiting Period (if any) began

  8. Date Coverage began

  9. Date Coverage will end

3) A health Insurance card is not considered an acceptable form of Proof of Health Care Coverage.

4) Please return all information (including verification of coverage letter) on one PDF.

Christal L. Schools
Administrative Support Coordinator
Virginia Commonwealth University - School of Medicine Division of Student Affairs
1201 E. Marshall Street, 4th Floor, Suite 200
PO Box 980565
Richmond, VA 23298

If you have difficulty uploading to PDF format, you may either fax the information to (804) 828-5115 or email

For additional questions regarding the compliance policy and/or procedures, please contact either Christal L. Schools, 804.827.1260 or Audrey Manley, 804.828.0998. The number for the University Student Health Services office is (804) 828-8828.

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Section I. Student Information 2020-21
Section II. Health Care Coverage Compliance Questions
Section III. Health Insurance Company Information
Section IV. Release of Information & Statement of Understanding
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