Student Health Benefit Waiver Criteria
Comparable coverage to the university plan must meet all of the waiver criteria requirements below.
- My plan is Affordable Care Act (ACA) compliant.
My plan covers the following essential health benefits:
- Emergency Services: care received for conditions that could lead to serious disability or death if not immediately treated, not penalized for going out-of-network or not having prior authorization.
- Hospitalization: treatment in a hospital for inpatient care including laboratory services and medication during the hospital stay.
- Laboratory services: testing provided to help a doctor diagnose an injury, illness or condition, or to monitor the effectiveness of a particular treatment.
- Maternity, newborn care and breastfeeding coverage: Care that women receive during pregnancy, through delivery, post-delivery and care for newborns.
- Mental health services and addiction treatment: inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. Limits must comply with state or federal parity laws.
- Outpatient Care: care received without being admitted to a hospital such as a doctor’s office or clinic.
- Pediatric services: well-child visits, vaccines, immunizations, dental and vision care
- Prescription drugs, including birth control coverage: medications that are prescribed by a doctor to treat an illness or condition, some prescription drugs can be excluded.
- Preventive services, wellness services and chronic disease management: including physicals, immunizations and screenings designed to prevent or detect certain medical conditions.
- Rehabilitative services and devices: Services to help recover or develop skills and device to help gain or recover mental and physical skills due to injury, disability or chronic condition.
- My current health insurance plan is NOT limited to emergency-only care and allows me to visit U.S. doctors, hospitals, laboratories and other health care providers in the local area where I will be residing and studying for the academic year.
- My plan covers me while in the state I will be residing in for the upcoming semester. [Note: if your current health insurance plan is a Medicaid plan, it must provide coverage for you in the state you will be residing in for the upcoming semester.]
- I will remain enrolled in health care coverage for the duration of the academic year.
- I understand am responsible for paying my deductible and any out-of-pocket costs for medical services that I receive.
Note: A deductible is the amount you pay for covered health care services before insurance plan starts to pay (e.g. with a $2,000 deductible you pay the first $2,000 of covered services for yourself, after you pay your deductible, you usually pay only a copayment or coinsurance for covered services). An out-of-pocket maximum is the total amount you pay each plan year for healthcare including co-pays, deductibles, and co-insurance. Once you have reached your out-of-pocket maximum, your plan will pay for 100% of the allowed amount for covered services.
For comparison purposes, the school-sponsored health insurance plan has a $150 deductible and a $3,000 out-of-pocket-maximum.