Health Form

Resident students must complete this medical history form with the assistance of a physician prior to arrival at LVC. LVC requires the following immunizations (listed on the form):

• TDAP/Adacel/Boostrix (circle)
• OPV (polio) series
• MMR (two doses)
• Varivax vaccine (two doses) or Varicella Disease
• Meningococcal (Menactra (A/C/Y/W-135) if the first dose before age 16, a booster is required
• Tuberculosis Testing (PPD) within the past 12 months
• Hepatitis B

The following immunizations are recommended, but not required:

• Hepatitis A
• HPV
• Meningitis B

Additional Forms

If you have any of the following conditions, please take the time to fill out the form(s) that is most relevant for you:

• Allergies/Asthma
• Physical Impairment

Health Insurance Coverage

Lebanon Valley College requires all residential international students to maintain medical insurance that provides coverage in the United States. Therefore, enrollment in the Lebanon Valley College-sponsored health insurance plan is automatic and the cost of the policy is included in the student’s tuition and fees invoice. In certain cases, students holding comparable insurance policy coverage may be eligible to waive enrollment in the LVC's health insurance plan. In addition to personal health insurance coverage, the comparable plan must include the following benefits and minimum limits in order to be considered for an exemption:

International Students Attending Classes at Lebanon Valley College
Emergency Accident & Sickness	$100,000	Can be included in personal health insurance if coverage extends to care in the United States.
Medical Evacuation	$250,000
Repatriation	$50,000

Additionally, students will provide evidence that the comparable policy has a health insurance claims office based in the United States. Students requesting a waiver review of their individual insurance policy should submit the following information to international@lvc.edu by Aug. 1 for the fall semester and Dec. 1 for spring semester:

• Insurance company name
• Insurance company phone number and claims address
• Policy number
• Policyholder name and date of birth
• Photocopy of policyholder ID (if already purchased)
• Detailed list of coverage benefits

After review and acceptance of your submitted waiver form, your Lebanon Valley College tuition invoice will be credited the automatic policy premium. Please note that the waiver request must be renewed every academic year.