Wellness Waiver form - The University of Texas at Brownsville 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name in the designated field. Ensure that you print your name clearly as this will be used for identification.
  3. Confirm that you are eighteen years of age or older by checking the appropriate box if available, or simply acknowledge this statement as part of your understanding.
  4. Read through the waiver agreement carefully. This section outlines the risks associated with participation in the Employee Wellness Program. Make sure you understand these risks before proceeding.
  5. Sign and date the form in the provided fields. Your signature indicates acceptance of all terms outlined in the waiver.
  6. Fill in your department name where prompted to ensure proper processing of your waiver.
  7. Once completed, save your document and follow any instructions for submission, ensuring it is sent to Human Resources as specified.

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Student Health Insurance The Board of Regents of The University of Texas System mandates health insurance for all students enrolled in the UT System health components.
An insurance waiver is a document that includes the employees declaration that you have been offered a plan, however, have chosen to refuse the coverage offered and why. Depending on the organization or reason for the request, an employee may be required to provide proof of outside coverage.
When an employee doesnt want health insurance from their employer, they waive coverage. Or, employees can waive coverage on behalf of a family member who was previously under their plan. A waiver of coverage is a form employees sign to opt-out of insurance.
The UT System Student Health Insurance Plan, which was selected by UT System to be affordable and provide the essential care required by the Affordable Care Act, is available to all students enrolled at a UT System institution and the eligible dependents of students who are enrolled in the plan.
A Waiver of Premium Rider is an add-on provision to a life insurance policy that ensures if the policyholder becomes seriously ill or disabled and is unable to continue working, the insurance company will waive the premium payments, allowing the policy to remain in force without any further payment from the
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