The example letter below, submitted by the international student’s insurance company on behalf of
the international student, is used to prove that the student attending the Milwaukee School of
Engineering (MSOE), has existing health insurance coverage while studying in the United States.
This example letter is the proof that is needed for MSOE to not charge a fee for the mandatory
international student insurance. This letter also verifies that the student is covered with their own
health insurance policy rather than the MSOE international student health insurance plan.
Below is an example letter that should be typed on official insurance company letterhead and signed
by the company’s representative. The proper information should be added in the blank spaces below.
INTERNATIONAL STUDENT PROOF OF HEALTH INSURANCE
This letter is to certify that the student named below has a health insurance policy with our
company that will cover the student for medical expenses and emergencies while the student is
studying in the United States.
The insured student’s full name: ___________________________________________.
The name of the insurance company is: _____________________________________ .
The group number for the student is # ______________________________________ .
The policy number for the student is # ______________________________________ .
The dates of coverage for this policy are:
Start date of policy (YYYY-MM-DD): ______________-____________-_________.
End date of policy (YYYY-MM-DD): ______________-____________-_________.
Insurance Representative name (please print) ________________________________________
Insurance Representative signature: ________________________________________________
Date: __________________ Company seal or mark (if applicable):