Insurance Waiver

Online insurance waiver applications for the Winter 2010 quarter are now being accepted. If you have been approved for a waiver for the Summer or Fall 2009 quarter you do not need to re-apply. An approved waiver is valid through the end of the Summer 2010 quarter so long as you maintain continuous coverage under your plan. Students will need to re-apply for a waiver for Fall 2010.

NOTE: All registered students, regardless of waiving the Student Insurance Plan, will have access to services provided at Student Health & Counseling Services.

• Eligibility Required
• Deadlines
• Application
• Verification Process
• Process for Adjusting Fees
• Appeals Process
• Loss of Coverage
• Should I waive?

Eligibility Required

Students who have access to an employer-sponsored insurance plan or an individual plan with a minimum of 6 months of continuous coverage that meet all minimum benefit levels will be eligible to waive the Student Insurance Plan. The minimum benefit requirements include:

• Plan year minimum benefit: $250,000 per condition per year or $500,000 per year; or aggregate lifetime maximum of $2 million or greater with a minimum of $500,000 per year.
• Annual Deductible: $300 or less.
• Out-of-pocket expense cap per year: $5,000 or less.
• Inpatient: Network coverage at 80% or higher and/or out-of-network coverage at 60% or higher.
• Outpatient: Network coverage at 80% or higher and/or out-of-network coverage at 60% or higher.
• Prescription coverage: Not less than $4,000 per year; ability to fill a prescription written by a local physician; pharmacy access nationwide.
• Mental Health coverage: Hospitalization - Network coverage at 80% or higher and/or out-of-network coverage at 60% or higher; Outpatient – at least 60% or higher for non-parity conditions, 80% or higher coverage for parity conditions.
• Geographic area covered: All medically necessary care - State of CA (minimum area), Emergency care - world wide.
• Have a facility providing full services within 30 miles of program location or 30 miles of residence while participating in program.
• Must stay in effect at all times while participating in program.
• US owned company headquartered and operating in the US.

Students having medical coverage through the Veterans Administration or Medi-Cal may apply for the waiver subject to service levels meeting the minimum benefit requirements. Medi-Cal applicants must demonstrate a history of at least six months of eligibility.

Deadlines

Students will be allowed to apply for a waiver commencing the beginning of Fall, Winter, or Spring quarter. Waivers cannot be applied mid-term and will not be processed for continuing students in summer term. Only new and re-admitted students will be allowed to apply for a waiver in the summer.

SHCS will conduct a waiver application and verification process for new waivers on the following schedule:

Application

Students can apply online during the application period. The deadline to submit an application for the Winter 2010 quarter is Sunday, December 20th.

Applications are accepted fall, winter and spring terms. Students will need to reapply each academic year by the applicable deadline for the term in which they wish to be granted a waiver. There is a $47 application processing fee. This application fee will be collected via the registration process.

You will need the following to begin the application process:

• SAA User ID and password
• Insurance company contact information
• nsurance policy group number, member ID, and summary of benefits

In addition, you will need to submit the following to complete the process:

• Electronic or hard-copy plan information and supporting insurance documents. You can upload these documents online or mail to Student Health.
• Consent to Disclose form must be submitted with your application.

Verification Process

SHCS will verify 100% of new waiver applications for all terms. SHCS will also verify all students with waivers a second time at some point during the year to ensure all policies are still in effect.

Students will be required to submit a signed Consent to Disclose form to SHCS allowing their insurance company to verify coverage details to SHCS.

If SHCS is unable to verify a student’s plan prior to the approval deadline or if SHCS is informed at any point that a student’s plan has terminated, SHCS may at any time re-apply the full insurance fee for the term in question.

Process for Adjusting Fees

Students should NOT PAY THEIR FEES until their waiver application has been processed. The insurance premium will be removed from the student’s fees and the application fee applied once the waiver application is fully processed and approved. No refunds will be processed through the Registrar’s Office if a student pays their fees prior to their waiver application approval.

If you have applied to waive, do NOT PAY YOUR FEES until you have received confirmation from SHCS about your application status.

Appeals Process

If a student’s application for waiver is denied, they may file an appeal with Student Health and Counseling Services by submitting the Insurance Waiver Appeal form. Appeals must be submitted within 30 days of receipt of notification of the denial.

Loss of Coverage

Students are required to maintain continuous coverage under an approved insurance health plan or the Student Insurance Plan at all times while enrolled at UCSF. Students may elect at the beginning of any term to cancel their approved waiver and enroll in the Student Insurance Plan.

If a student loses coverage under their employer sponsored health plan mid-term, the student must submit to the University written notification of the loss of coverage and cancellation of the waiver within 30 days of the termination date of their approved insurance health plan. The student must pay the entire premium for the term in which they are electing to enroll. Mid-term enrollment does not allow for any proration of the premium.

 To enroll mid-term, students should submit a written request to SHCS. To enroll at term, students should provide a letter requesting cancellation of their waiver to SHCS.

Should I Waive Coverage?

To waive, or not to waive? To answer this question, please review the information below to help you decide.

The reason health insurance is a mandatory condition of enrollment is to ensure (a) you have access to medical care anytime you need it, (b) you will not experience a financial catastrophe in receiving the care you need and (c) you have the help you need to avoid compromising your academic progress.

The University is not in the "insurance business" but each campus serves students by negotiating a plan specifically designed to meet the unique needs of students on that campus.

Even if you waive the Student Insurance Plan, you will still have access to Student Health and Counseling Services. Those services include:

• Primary Care
          • Labs ordered by a SHCS provider to Quest Diagnostics
          • Physical Exams & Pap smears
• Counseling and Psychological Services
• Traveler's Health
• Wellness Programs & Outreach

The Student Insurance Plan is designed to "complement" the services offered at Student Health and Counseling. It provides benefits including emergency/after hours care, hospitalization, surgery, specialized care not provided at Student Health and Counseling, specialized testing, e.g. CT scans or MRI's. It would be ideal if your private plan did the same, without you having to leave the campus area.

Please see the links below highlighting the medical, dental, vision, and prescription benefits of the Student Insurance Plan. Compare to your alternative plan to see what works best for you and your family.

• Medical Benefits
• Dental Benefit
• Vision Benefits
• Prescription Benefits

If you have additional questions, please contact us.