Alumni Insurance Program
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Monday-Friday, 8am-6pm Eastern Time

Reinstatement Form

If your payment is more than 45 days late, you need to complete a Reinstatement Form. If for any reason your reinstatement is declined, your payment will be refunded to you.

  • Download the Reinstatement Form below
  • Complete the Insurance Reinstatement Form with your electronic signature.
  • Email your completed form to or FAX it to 1-614-481-2400.
  • Make your payment online on the Pay My Bill page
Download a Reinstatement Form (Word .doc)  

The Your Alumni Association receives financial benefits from the administrator that provides this program. These benefits fund alumni programs and activities.