Insurance for

 

Student Help Desk

 

UNC System-Wide Student Health Insurance Plan for 2012-2013 Frequently Asked Questions & Answers

(Last revised October 2012)


Click on any of the questions to be directed to the answer

Questions about Federal Regulations 

  1. What does "portability of insurance" mean?
  2. Does UNC consider a "health care sharing ministry" as an acceptable means to meet the hard waiver requirement?

Questions about Hard Waiver 

  1. What does "Hard Waiver" mean?
  2. Why is Student Health Insurance required?
  3. What are the eligibility requirements for the UNC System-Wide Student Health Insurance Hard Waiver Plan?
  4. Who is NOT eligible for the UNC System-Wide Student Health Insurance Hard Waiver Plan?
  5. How does a student waive out of coverage under the UNC System-Wide Student Health Insurance Hard Waiver Plan?
  6. The waiver requirement calls for "existing Creditable Coverage". What does Creditable Coverage mean?
  7. Does a student need to waive every semester?
  8. Can a student enroll in the UNC System-Wide Student Health Insurance Hard Waiver Plan after Waiving out?
  9. What is ineligibility?
  10. How can eligible students enroll in the UNC System-Wide Student Health Insurance Hard Waiver Plan?
  11. What happens if a student does not waive out of the UNC System-Wide Student Health Insurance Hard Waiver Plan?
  12. How can I enroll my spouse/domestic partner and/or dependent child(ren) if I am eligible for the hard waiver plan?
  13. When will I receive my insurance card?
  14. How is the Student Health Insurance different from the Health Fee on my bill each semester?
  15. When is the insurance premium payment for the UNC System-Wide Student Health Insurance Hard Waiver Plan due?
  16. Are Hard Waiver students billed the UNC System-Wide Student Health Insurance Hard Waiver Plan premium on a policy year basis or per each semester?
  17. When does the charge for the UNC System-Wide Student Health Insurance Hard Waiver Plan become final for the semester?
  18. Does the premium get included in the cost of attendance used by the Financial Aid Office when assessing financial need?
  19. If a student is paying through a payment plan, will the insurance premium for the UNC System-Wide Student Health Insurance Hard Waiver Plan be included as part of the monthly payment plan option?
  20. Will the cost of the UNC System-Wide Student Health Insurance Plan premium qualify for filing a 1098-T?

Questions about UNC System-Wide Student Health Insurance Hard Waiver Plan Coverage 

  1. What happens if I do not go to the Student Health Center first for treatment?
  2. If I am already established with my own provider, what do I need to do?
  3. Does the Student Health Insurance Plan also cover treatment received outside of North Carolina?
  4. Will prescription drugs be covered on this plan?
  5. Will injections and immunizations be covered on this plan?
  6. What benefits are mandated by the State of North Carolina?
  7. If my UNC System-Wide Student Health Insurance Hard Waiver Plan includes a wellness benefit enhancement, what will it cover?
  8. How can I find out if specific treatments or services are covered?
  9. Is any continuation of coverage available?
  10. Is the UNC System-Wide Student Health Insurance Plan (the Hard Waiver Plan or the Voluntary Plan) primary coverage?
  11. What if a student is enrolled in 2 or more institutions?

Questions about International Student Coverage 

  1. Are international students eligible for coverage under the UNC System-Health Insurance Hard Waiver Plan?
  2. Can international students waive out of the UNC System-Wide Student Health Insurance Hard Waiver Plan?
  3. How can international students enroll in the UNC System-Wide Student Health Insurance Hard Waiver Plan?
  4. Does the UNC System-Wide Student Health Insurance Hard Waiver Plan cover immunizations required for international travel?
  5. Does the UNC System-Wide Student Health Insurance Hard Waiver Plan cover services rendered outside the US?

Questions about the UNC System-Wide Student Health Insurance Voluntary Plan Eligibility & Coverage 

  1. If a student is not eligible for the UNC System-Wide Student Health Insurance Hard Waiver Plan, how can he/she enroll in the UNC System-Wide Student Health Insurance Voluntary Plan?
  2. If a student will be purchasing the UNC System-Wide Student Health Insurance Voluntary Plan, by when must this be completed?
  3. How can I enroll my spouse/domestic partner and/or dependent child(ren) if I am eligible for the Voluntary Plan?
  4. Are the benefits for spouses/domestic partners and/or dependent child(ren) the same as for the covered student?
  5. If I enroll my spouse/domestic partner and/or dependent child(ren), can they also be treated at the Student Health Center?
  6. When will I receive my insurance card?

Questions about the Voluntary Dental Student Plan Coverage 

  1. What is the UNC System-Wide Voluntary Student Dental Plan?

What are some Commonly Used Health Insurance Terms  

  1. Accident
  2. Covered Person
  3. Elective Treatment
  4. Eligible Expense
  5. Emergency Medical Condition
  6. Injury
  7. Medical Necessity/Medically Necessary
  8. Pre-Existing Condition
  9. Reasonable and Customary (R&C)
  10. Sickness
  11. *Pre-Existing Conditions Limitation

Questions about Federal Regulations 

  1. What does "portability of insurance" mean? 

    The Health Insurance Portability and Accountability Act (HIPAA) provides rights and protections for participants and beneficiaries in group health plans. HIPAA includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. The student is responsible to maintain documentation of continuous coverage.

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  3. Does UNC consider a "health care sharing ministry" as an acceptable means to meet the hard waiver requirement? 

    Yes. A health sharing ministry is defined as an organization described in Section 501(c) of the IRC (including corporations, and any community chest, fund, or foundation, organized and operated exclusively for religious, charitable, scientific, or testing for public safety) and is exempt from taxation under section 501(a). Members of the ministry share a common set of ethical or religious beliefs and share medical expenses, and retain membership even after they develop a medical condition. The health sharing ministry must have been in existence (and sharing medical expenses) at all times since December 31, 1999, and must conduct an annual audit by an independent certified public accountant, available to the public upon request. Pearce & Pearce, as part of the waiver request process, ensures that any such waiver request that comes from a health sharing ministry meets the above conditions that are found in the PPACA.

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Questions about Hard Waiver 

  1. What does "hard waiver" mean? 

    The term "hard waiver" means that any student meeting three specific criteria (see #3 below) is required to show evidence of an existing creditable coverage health insurance policy OR enroll in the UNC System-Wide Student Health Insurance Hard Waiver Plan.

    "Hard waiver" does not mean a student must enroll in the UNC System-Wide Student Health Insurance Hard Waiver Plan; it means that the student insurance will be charged with the school's fees on the student's university account and can only be removed if the student shows evidence of an existing creditable coverage health insurance. A student is encouraged to compare the UNC System-Wide Student Health Insurance Hard Waiver Plan with other options, e.g., being a dependent on a parent's health insurance plan, an employer's health insurance plan, or have individual plan coverage through another source.

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  3. Why is Student Health Insurance required? 

    In August 2009, the UNC Board of Governors approved the implementation of a "hard waiver" student health insurance plan on all sixteen 4-year campuses beginning in fall 2010. The term "hard waiver" means any student meeting three specific criteria is required to show evidence of an existing "creditable coverage" health insurance policy OR enroll in the UNC System-Wide Student Health Insurance Hard Waiver Plan.

    "Hard waiver" does not mean a student must enroll in the UNC System-Wide Student Health Insurance Hard Waiver Plan; it means a student must show evidence of creditable coverage health insurance, and enrolling in the UNC system-wide plan is one means to meet that requirement. A student is encouraged to compare the UNC System-Wide Student Health Insurance Hard Waiver Plan against other options, e.g., being a dependent on a parent's health insurance plan, or having an employer's health insurance plan, having individual plan coverage through another source.

    The UNC System-Wide Student Health Insurance Hard Waiver Plan provides a common set of base benefits with campus-selected plan enhancements. The UNC System-Wide Student Health Insurance Hard Waiver Plan policy is in effect from August 1st - July 31st. A student eligible for the UNC System-Wide Student Health Insurance Hard Waiver Plan is billed by semesters (defined as August 1st - December 31st and January 1st - July 31stt). For more information please visit your school's page at www.studentinsurance.com.

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  5. What are the eligibility requirements for the UNC System-Wide Hard Waiver Plan? 

    A student is defined as eligible under the hard waiver requirement and is eligible for the Hard Waiver Plan as follows:

    • Undergraduate students

    • Enrolled in a minimum of 6 Main Campus credit hours per semester, AND
    • Enrolled in a degree-seeking program, AND
    • Eligible to pay the university Student Health Fee.

      Graduate students

    • Enrolled in a minimum of 6 Main Campus credit hours per semester (UNCW and UNCCH have a threshold of 1 or more Main Campus credit hours per semester), AND
    • Enrolled in a degree-seeking program, AND
    • Eligible to pay the university Student Health Fee.

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  6. Who is NOT eligible for the UNC System-Wide Student Health Insurance Hard Waiver Plan? 

    Those who are not eligible include:

    • North Carolina State employees who are eligible for employer paid health insurance coverage under the State Health Plan of NC,
    • Students enrolled ONLY in distance education courses.
    • Undergraduate students enrolled in less than 6 Main Campus credit hours per semester.
    • Graduate students enrolled in less than 6 Main Campus credit hours per semester (UNCCH and UNCW enrolled in less than 1 Main Campus credit hour per semester).

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  7. How does a student waive out of coverage under the UNC System-Wide Hard Waiver Plan? 

    Any student meeting all three specific criteria who has an existing creditable coverage health insurance policy is able to waive out of the UNC System-Wide Student Health Insurance Hard Waiver Plan easily and quickly on-line. No paperwork is required. The web portal to waive out of the UNC System-Wide Student Health Insurance Hard Waiver Plan is located at www.studentinsurance.com, with waiver verification beginning on June 1st for fall semester and November 1st for spring/summer semester. Students will receive an email immediately after waiving which includes a Confirmation number, providing proof of waiver submission. The Verification Email will be sent after the submitted waiver is verified. The waiver and enrollment period will end 31 days after August 1st, unless noted on the school's page at www.studentinsurance.com.

    If you do not meet the eligibility requirements for the UNC System-Wide Student Health Insurance Hard Waiver Plan, you do not need to submit an online waiver request providing proof of an existing creditable coverage health insurance.

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  9. The waiver requirement calls for "existing Creditable Coverage". What does Creditable Coverage mean? 

    Creditable Coverage means coverage under any of the following: (a) a self-funded employer group health plan under the Employee Retirement Income Security Act of 1974; (b) group or individual health insurance coverage; (c) part A or part B of title XVIII of the Social Security Act; (d) Title XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928; (e) Chapter 55 of Title 10, United States Code; (f) a medical care program of the Indian Health Service or of a tribal organization; (g) a state health benefits risk pool; (h) a health plan offered under chapter 89 of Title 5, United States Code; (i) a public health plan (as defined by federal regulations); (j) a health benefit plan under section 5(e) of the Peace Corps Act (22 U.S.C. § 2504(e) ); (k) the Health Insurance Program for Children established in Part 8 of Chapter 108A of the General Statutes, or any successor program.

    You are encouraged to check with your insurance company to find out if your coverage is defined as "creditable coverage" under ERISA. Creditable Coverage includes continuation or conversion coverage but does not include accident only, credit, coverage for onsite medical clinics, disability income, Medicare supplement, long-term care insurance, dental, vision, coverage issued as a supplement to liability insurance, insurance arising out of a workers' compensation or similar law, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.

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  11. Does a student need to waive every semester? 

    The eligibility requirement for the UNC System-Wide Student Health Insurance Hard Waiver Plan must be met each semester.

    Students who submit a waiver for the fall semester will be able to select 'Yes or No' if they want to use the same waiver insurance information for the Spring/Summer semester. If the answer is 'Yes', the information will automatically be submitted for verification again for the Spring/Summer semester. Therefore, the student completes the waiver request form once a school year, but it is verified each semester. If the answer is 'No', it will be the student's responsibility to resubmit or renew his Spring/Summer waiver during the waiver period.

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  13. Can a student enroll in the UNC System-Wide Student Health Insurance Hard Waiver Plan after Waiving out? 

    The UNC System requires a student who meets the hard waiver eligibility requirements to have insurance each semester while enrolled at a UNC System campus. A student who, initially waived coverage under the UNC System-Wide Student Health Insurance Hard Waiver Plan but subsequently experiences ineligibility under another creditable plan may elect to enroll for coverage under the UNC System-Wide Student Health Insurance Hard Waiver Plan within 31 days of the date of ineligibility under another creditable plan by contacting Pearce & Pearce, Inc. at 1-888-622-6001 or qualifier@studentinsurance.com. Or by logging into your secure online account at www.studentinsurance.com and clicking the button 'switch to enroll' under the drop down 'student options'.

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  15. What is ineligibility? 

    Ineligibility may come in many forms, such as aging off a parent's group plan; a student gets married and is not eligible to continue on the parent's plan; or, exhausting COBRA. However, there are other forms of qualifying events. They are: if you are a new or transfer student to the school, birth or adoption of a child, and if a student, spouse/domestic partner, or child arrives in the country. Please remember with every qualifying event, students (spouses/domestic partner and/ or child(ren) have 31 days of eligibility to enroll in the UNC System-Wide Student Health Insurance Plan. For more information concerning qualifying events send an email to Pearce & Pearce, Inc. at qualifier@studentinsurance.com.

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  17. How can eligible students enroll in the UNC System-Wide Student Health Insurance Hard Waiver Plan? 

    Students eligible for the Hard Waiver plan are charged the premium on their semester bill and if they do not waive out they will be insured under the UNC System-Wide Student Health Insurance Hard Waiver Plan. If you are eligible for the Hard Waiver plan, you should complete the Hard Waiver Enrollment form online at www.studentinsurance.com on the school's page. You will then be eligible for the insurance services before the school exports the final list of insured students. If you do not complete the Hard Waiver Enrollment you are still insured, but will not receive your insurance card, nor show active with the insurance company until the final list is exported from your school to Pearce & Pearce, Inc. If you are enrolling in the Voluntary Plan you should complete the Voluntary Enrollment request form at www.studentinsurance.com on your school's page during the Open Enrollment period. If your Voluntary Enrollment request is approved, you may enroll online. Payment for the Voluntary Plan will be due in full at the time of enrollment.

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  19. What happens if a student does not waive out of the UNC System-Wide Student Health Insurance Hard Waiver Plan? 

    Students who meet the three criteria (see #3 above) and do not successfully waive through the web portal at www.studentinsurance.com, will be automatically enrolled in the UNC system-wide plan each semester, and are obligated for the cost of the plan's premium for that semester. The UNC system-wide plan's premium is included in the "cost of attendance" used for financial aid consideration.

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  21. How can I enroll my spouse/domestic partner and/or dependent child(ren) if I am eligible for the hard waiver plan? 

    If you are enrolled in the UNC System-Wide Student Health Insurance Hard Waiver Plan, coverage for your eligible dependents (spouse/domestic partner and/or dependent children) may also be purchased. You must enroll them online at www.studentinsurance.com during the Open Enrollment period. If the student insurance premium UNC System-Wide Student Health Insurance Hard Waiver Plan was charged to your fees, you should click on Hard Waiver Plan enrollment on your school's page. Complete the student information form and then click the proper links to add your eligible dependents. Payment for any dependents will be due at the time of the enrollment. A dependent may become eligible for coverage under the UNC System-Wide Student Health Insurance Voluntary Plan only when the student becomes eligible (within the Open Enrollment period) or within 31 days of a Qualifying Event.

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  23. When will I receive my insurance card? 

    If you are in the Pearce & Pearce, Inc. database as an active insured, you should receive an insurance card within 3-5 business days. If you do not receive your card immediately, log into your online account at www.studentinsurance.com and check the date it was mailed and the address that was used. From your account you are able to request a new or replacement insurance card., update any personal information and also print an ID card online through your account.

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  25. How is the Student Health Insurance different from the Health Fee on my student bill each semester? 

    The required student health fee is not insurance. This fee covers the basic care offered at Student Health Services, including Medical Clinic, Sports Medicine Clinic and Women's Health Clinic office visits. Charges for laboratory procedures, x-rays and prescriptions are provided at a discounted cost. Your student health fee also pays for wellness programs to enhance your personal health and well-being.

    Health insurance offsets the cost of services not covered under the student health fee. It also gives students access to services not available at the Student Health Center. The UNC System-Wide Student Health Insurance Plan covers the student anywhere in the world for a covered sickness and injury.

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  27. When is the insurance premium payment for the UNC System-Wide Student Health Insurance Hard Waiver Plan due? 

    The student insurance premium for the UNC System-Wide Student Health Insurance Hard Waiver Plan is due at the same time as all other charges on the student's university account.

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  29. Are Hard Waiver students billed the insurance premium on a policy year basis or per each semester?  

    If you are eligible for the UNC System-Wide Student Health Insurance Hard Waiver Plan, the premium is included in your student bill each semester. There is no proration of premiums.

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  31. When does the charge for the UNC System-Wide Student Health Insurance Hard Waiver Plan become final for the term?  

    The insurance charge becomes final if a student fails to successfully waive out of the UNC System-Wide Student Health Insurance Hard Waiver Plan at www.studentinsurance.com during the waiver period.

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  33. Does the insurance premium get included in the cost of attendance used by the Financial Aid Office when assessing need? 

    The cost for UNC System-Wide Student Health Insurance Hard Waiver Plan is included in the cost of attendance for all financial aid applicants. If the student health insurance charge is on the student's account in the cashier's office within 10 days of the beginning of each semester, financial aid funds will automatically pay off that charge if aid funds are sufficient to do so after other university charges are paid. If the health insurance charge is applied after aid funds are credited, or if the student's total aid is not sufficient to cover all university charges, the student will have to pay for the health insurance charge from other sources.

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  35. If a student is paying through a payment plan, will the insurance premium for the UNC System-Wide Student Health Insurance Hard Waiver Plan be included as part of the Monthly Payment Plan option?  

    Yes, the Hard Waiver insurance premium is treated the same as any other charge on the student's university account.

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  37. Will the cost of the UNC System-Wide Student Health Insurance Hard Waiver Plan premium qualify for filing a 1098-T?  

    According to the IRS instructions, "The following are not qualified tuition and related expenses: Charges and fees for room, board, insurance, medical expenses (including student health fees), transportation, and similar personal, living, or family expenses."

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Questions about the Hard Waiver Insurance Plan Coverage 

  1. What happens if I do not go to the Student Health Center first for treatment?  
    • Deductibles and co-pays are waived only when services are rendered at Student Health Services.
    • Deductibles and co-pays apply to all services received outside the Student Health Services.

    The reason for seeking treatment first from the Student Health Center is that the UNC System-Wide Student Health Insurance Hard Waiver Plan's applicable deductibles and co-pays are waived only when covered medical services are rendered at the Student Health Center. If a student goes to an off-campus medical provider, the student will be responsible for co-pays, deductibles, and any portion of the bill not covered by the UNC System-Wide Insurance Plan.

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  2. If I am already established with my own provider, what do I need to do? 

    If you are already seeing a provider you should check to see if that provider is in network by going to your school's page at www.studentinsurance.com. Providers not in the MedCost PPO Network or the First Health Network, may be directly contracted under the plan for students and their dependents only. Providers may send an e-mail request to: ppoprovider@studentinsurance.com. If your provider is not in the network, the plan will only pay 70% of R&C charges for covered Sicknesses and Injuries.

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  4. Does the UNC System-Wide Student Health Insurance Hard Waiver Plan also cover treatment received outside of North Carolina? 

    Yes, the UNC System-Wide Student Health Insurance Hard Waiver Plan provides coverage in all 50 States, US Territories, and foreign countries.

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  6. Will prescription drugs be covered on this plan?  

    Outpatient prescription drugs, including prescription birth control, are covered with a limit of one 30 day supply per prescription or refill per month. Prescriptions may be filled at the Student Health Center or by informedRx, a SXC company participating pharmacy, and will be covered as defined in the Plan Summary.

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  8. Will injections and immunizations be covered on this plan?  

    The plan has a $500.00 injection and immunization benefit. Please check www.healthcare.gov to check the list of injections/immunizations covered under the Preventative Care/Wellness Benefit with $0.00 cost sharing. Eligible expenses for injections and immunizations are covered at 100% if administered by the Student Health Center and 80% if not administered by the Student Health Center up to the plan's maximum injection and immunization benefit per policy year. Deductibles and co-pays are waived only when services are rendered at the Student Health Center for the injection/immunization benefit, and will apply to all services received outside the Student Health Center.

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  10. What benefits are mandated by the State of North Carolina?  

    The State of North Carolina regulation mandates coverage for: diagnostic, therapeutic or surgical procedures involving any bone or joint of the jaw, face or head; anesthesia and hospital charges in connection with dental procedures under certain circumstances; hospital stay of 48 hours following a normal vaginal delivery and 96 hours following a cesarean section and post-delivery care in the event of earlier discharge; bone mass measurement for the diagnosis and evaluation of osteoporosis for qualified individuals; prescription contraceptives drugs or devices; colorectal cancer screening; emergency services expense; mammograms; examinations and laboratory tests for the screening for the early detection of cervical cancer; prostates specific antigen tests; diabetes equipment, supplies and outpatient self-management training; hearing screening for dependent newborn children; health care services associated with participation in covered clinical trials; surveillance tests for women at risk for ovarian cancer; breast reconstruction following a mastectomy shall include coverage for all stages and revisions of reconstructive breast surgery performed on a non-diseased breast to establish symmetry if reconstructive surgery on a diseased breast is performed, as well as coverage for prostheses and physical complications in all stages of mastectomy, including lymphedemas on the same basis as any other illness. Reconstruction of the nipple/areolar complex following a mastectomy is covered without regard to the lapse of time between the mastectomy and the reconstruction, subject to the approval of the treating physician; and any other applicable mandated benefits.

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  12. If my UNC System-Wide Student Health Insurance Hard Waiver Plan includes a wellness benefit enhancement, what will it cover? 

    "Wellness Services" include, but are not limited to, routine doctor's visits, routine physical examinations, prescription vitamins, preventive laboratory (examples: STI screening, Comprehensive Metabolic Panel, Basic Metabolic Panel, Electrolyte Panel, Liver Panel, Lipid Profile), preventive x-ray services, weight counseling, testing for ADD and ADHD, testing for allergies, and prescriptions for smoking cessation.

    The Company will pay 100% of the reasonable and customary (R&C) charges up to the maximum per policy year as defined in the plan summary for your school. The charges must be incurred while the Covered Student is insured. Eligible expenses for injections and immunizations are payable under the benefit for injections and immunizations only.

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  14. How can I find out if specific treatments or services are covered? 

    To view the UNC System-Wide Student Health Insurance Hard Waiver Plan summary and a complete list of plan exclusions please review the brochure by going to your school's page at www.studentinsurance.com or review the entire policy located in your secure online account with Pearce & Pearce, Inc.

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  16. Is any continuation of coverage available? 

    A student enrolled in the 2011-2012 UNC System-Wide Student Health Insurance Plan who graduates or discontinues enrollment at a UNC campus, may continue coverage under the 2011-2012 UNC System-Wide Voluntary Plan for an additional 3 months. Such continuance has an aggregate maximum benefit of $100,000 per injury or sickness. In no event, however, will the maximum amount of continued coverage exceed the difference between the UNC System-Wide Voluntary Plan Aggregate Maximum Benefit amount per injury or sickness, and the amount paid for the eligible expenses incurred by the student prior to graduation or ineligibility for that specific injury or sickness. A written request for continued coverage and payment of the premium must be made within 31 days of termination of the coverage period in which the student is enrolled. Continuation of coverage will be subject to all of the terms of the policy.

    A student who successfully waived coverage from the campus plan for the fall and/or the spring/summer coverage period(s) and who maintains the hard waiver eligibility criteria as well as coverage under his or her non-campus plan for the entire Coverage period waived, and graduates or discontinues enrollment at a UNC System campus and is no longer covered under his or her non-campus plan, may elect to purchase 3 months of coverage under the 2011-2012 UNC System-Wide Voluntary Plan if written request and payment of the premium is made within 31 days of the end of the coverage period waived.

    Any student who successfully waived and fails to comply with the coverage requirements of the UNC System-Wide Student Health Insurance Plan will not be eligible to purchase the 3 months of coverage under the 2011-2012 UNC System-Wide Voluntary Plan.

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  18. Is the UNC System-Wide Student Health Insurance Plan primary coverage? 

    Yes, the UNC System-Wide Student Health Insurance Plan is primary coverage.

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  20. What if a student is enrolled in 2 or more institutions? 

    If a student is enrolled in 2 or more institutions simultaneously, enrollment in the UNC System-Wide Student Health Insurance Plan would be at the school where the Student Health Fee is paid.

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Questions about International Student Coverage  

  1. Are International students eligible for the UNC System-Wide Hard Waiver Plan? 

    International students studying at a UNC System school with an F-1 or J-1 visa that are eligible under the hard waiver requirements can enroll in the Hard Waiver Plan. Coverage for these international students will be the same as coverage for domestic students. For information about international students waiving out of the Hard Waiver Plan, contact your school's International Programs Office. International students not eligible for the Hard Waiver Plan can be covered by the Voluntary Plan if they meet the Voluntary Plan eligibility criteria.

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  3. Can international students waive out of the UNC System-Wide Hard Waiver Plan? 

    International students requesting to waive, must submit an online waiver form and a copy of their international plan certificate of coverage, benefits and exclusions to Perce & Pearce, Inc. The international plan must meet the university's required coverage for international plans. International students must contact their school's International Programs Office for specific, allowable exceptions and to obtain any necessary paperwork. All waivers for international students must be completed within the waiver/enrollment period at www.studentinsurance.com.

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  5. How can international students enroll in the UNC System-Wide Hard Waiver Plan? 

    Students eligible for the Hard Waiver Plan should complete the Hard Waiver Enrollment form online on the school's page online at www.studentinsurance.com. The student will then be eligible for the insurance services before the school exports the final list of insured students to Pearce & Pearce, Inc. If you do not complete the Hard Waiver Enrollment you are still insured, but will not receive your insurance card, nor show as being active with the insurance company until the final list is exported from the school to Pearce & Pearce, Inc. If you are enrolling in the Voluntary Plan you should complete the Voluntary Enrollment form online on your school's page at www.studentinsurance.com during the open enrollment period.

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  7. Does the UNC System-Wide Student Health Insurance Plan cover immunizations required for international travel? 

    Injections and immunizations are covered, including flu shots at the Student Health Center; injections for allergies; and, needle stick HIV testing administered in the doctor's office. Deductibles and Co-pays are waived only when services are rendered at the Student Health Center, and will apply to all services received outside the Student Health Center. Benefit maximums for these services are found online at www.studentinsurance.com under your university's Plan Summary.

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  9. Does the Plan cover services rendered outside the US? 

    The UNC System-Wide Student Health Insurance Plan provides coverage for students while in all 50 US states, US territories, and foreign countries. If the covered person receives medical services while outside the US, he or she needs to simply submit claim forms and any other required or necessary documents to Pearce Administration for claims processing.

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Questions about the UNC System-Wide Student Health Insurance Voluntary Plan Enrollment & Coverage  

  1. If a student is not eligible for the UNC System-Wide Student Health Insurance Hard Waiver Plan, how can he/she enroll in the UNC System-Wide Student Health Insurance Voluntary Plan? 

    UNC System students who do not fall into the requirements of the UNC System-Wide Student Health Insurance Hard Waiver Plan, may purchase the UNC System-Wide Student Health Insurance Voluntary Plan online at www.studentinsurance.com if they are:

    • Eligible to pay the university Student Health Fee., AND
    • Enrolled in a minimum of 6 Main Campus credit hours per semester, OR
    • Enrolled in a degree-seeking program
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  3. If a student will be purchasing the UNC System-Wide Student Health Insurance Voluntary Plan, by when must this be completed? 

    Students enrolling themselves, a spouse/domestic partner, and/or dependent child(ren), in the UNC System-Wide Student Health Insurance Voluntary Plan must do so before the close of open enrollment which ends 31 days after the listed coverage effective dates of the fall and spring/summer coverage terms. The only exceptions are the following qualifying events (with appropriate documentation):

    1. Adding a new spouse/domestic partner or dependent child(ren) (within 31 days of marriage, birth or adoption).
    2. Enrolling as a new or transfer student (within 31 days of date of enrollment at the University).
    3. Ineligibility under another creditable plan (within 31 days of loss of coverage).
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  5. How can I enroll my spouse/domestic partner and/or dependent child(ren), if I am eligible for the Voluntary Plan?  

    If you are enrolled in a UNC System-Wide Student Health Insurance Plan, coverage for your spouse/domestic partner and/or dependent child(ren) may be purchased. You must enroll them online at www.studentinsurance.com during the Open Enrollment period. You should click on Voluntary Enrollment on your school's page and complete the request form. Once you are approved, complete the student information form to enroll yourself in the UNC System-Wide Student Health Insurance Voluntary Plan and then click the proper links to add your dependents. Payment for students and/or dependents placed on a UNC System-Wide Student Health Insurance Plan will be due at the time of the enrollment. A dependent may become eligible or coverage under the UNC System-Wide Student Health Insurance Voluntary Plan only when the student becomes eligible within the Open Enrollment period or within 31 days of a Qualifying Event.

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  7. Are the benefits for a spouse/domestic partner and/or dependent child(ren) the same as the covered student? 

    Yes. For the 2012-2013 school year, the benefits for hard waiver students, voluntary students, spouses and dependents will have the exact same benefits.

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  9. If I enroll my spouse/domestic partner and/or dependent child(ren), can they also be treated at the Student Health Center?  

    Students must check with the school's Student Health Center to find out if spouses/domestic partners and/or dependent child(ren) are eligible to be treated at the Student Health Center.

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  11. When will I receive my insurance card? 

    If you are in the Pearce & Pearce, Inc. database as an active insured, you should receive an insurance card within 3-5 business days. If you do not receive your card immediately, log into your online account at www.studentinsurance.com and check the date it was mailed and the address that was used. From your account you are able to request a new or replacement insurance card and update any personal information, and print an ID card online through your account.

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Questions about the Voluntary Dental Student Plan Coverage

  1. What is the UNC System Voluntary Dental Student Plan? 

    In addition to the UNC System-Wide Student Health Insurance plan, there is a UNC System-Wide Voluntary Dental Plan available to all students. This plan is separate from the UNC System-Wide Student Health Insurance Plan and it is a student's choice to enroll or not.

    The information about the voluntary dental plan can be found at www.studentinsurance.com and in your online account at www.studentinsurance.com. For the 2012-2013 year, the dental plan does have a $25.00 deductible per visit.

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What are some Commonly Used Health Insurance Terms?

  1. Accident  means an occurrence which: (a) is unforeseen; (b) is not due to or contributed to by sickness or disease of any kind; and, (c) causes injury.
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  3. Covered Person  means a Covered Student while coverage under the Policy is in effect and those Dependents with respect to whom a Covered Student is insured.
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  5. Elective Treatment  medical treatment, which is not necessitated by a pathological change in the function or structure in any part of the body, occurring after the Covered Person's effective date of coverage.

    Elective treatment includes, but is not limited to: tubal ligation; vasectomy; breast reduction unless as a result of mastectomy; sexual reassignment surgery; submucous resection and/or other surgical correction for deviated nasal septum, other than necessary treatment of covered acute purulent sinusitis; treatment for weight reduction;learning disabilities; immunizations; botox injections; treatment of infertility and routine physical examinations.

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  7. Eligible Expense  as used herein means a charge for any treatment, service or supply which is performed or given under the direction of a Doctor for the Medically Necessary treatment of a Sickness or Injury that is: (a) not in excess of the Reasonable and Customary charges; or (b) not in excess of the charges that would have been made in the absence of this coverage; (c) is the negotiated rate, if any, and (d) incurred while the Policy is in force as to the Covered Person except with respect to any expenses payable under the Extension of Benefits Provision.
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  9. "Emergency Medical Condition" means a medical condition that manifests itself by acute symptoms of sufficient severity, including, but not limited to, severe pain or by acute symptoms developing from a chronic medical condition that would lead a prudent lay person, possessing an average knowledge of medicine and health, to reasonably expect the absence of immediate medical attention to result in any of the following: (a) placing the health of an individual, or with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy; (b) serious impairment to such person's bodily functions; (c) serious dysfunction of any bodily organ or part; (d) serious disfigurement.
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  11. Injury means bodily injury due to an Accident which: (a) results solely, directly and independently of disease, bodily infirmity or any other causes; (b) occurs after the Covered Person's effective date of coverage; and (c) occurs while coverage is in force.

    All injuries sustained in any one Accident, including all related conditions and recurrent symptoms of these injuries, are considered one injury.

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  13. Medical Necessity/ Medically Necessary means the covered services or supplies: (a) provided for the diagnosis, treatment, cure or relief of a health condition, illness, Injury, or disease; and except as allowed for Clinical Trials, not for Experimental/Investigational or cosmetic purposes; (b) necessary for and appropriate to the diagnosis, treatment, cure or relief of a health condition, illness, Injury, or disease, or its symptoms; (c) within generally accepted standards of medical care in the community, (d) not solely for the convenience of the Covered person, his or her Immediate Family, or the provider.
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  15. Pre-Existing Condition*  means a Sickness, or Injury, or pregnancy for which medical care, treatment, diagnosis, or advice was received or recommended within the 6 months prior to the Covered Person's effective date of coverage under the Policy.
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  17. Reasonable and Customary (R&C)  means the charge, fee, or expense which is the smallest of: (a) the actual charge; (b) the charge usually made for a covered service by the provider who furnishes it; (c) the negotiated rate, if any; and, (d) the prevailing charge made for a covered service in the geographic area by those of similar professional standing.
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  19. Sickness means disease, illness, or Complications of Pregnancy including related conditions and recurrent symptoms of the Sickness which begins after the effective date of a Covered person's coverage. All Sicknesses due to the same or a related cause are considered One Sickness.
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  21. *Pre-Existing Conditions Limitation 
    Expenses incurred by a Covered Person as a result of a Pre-Existing Condition will not be considered Eligible Expenses for a period of 12 months of continuous coverage while covered under the Policy. This limitation will not apply if, during the period immediately preceding the Covered Person's effective date of coverage under the Policy, the Covered Person was covered under prior Creditable Coverage for 12 consecutive months. Prior Creditable Coverage of less than 12 months will be credited toward satisfying the Pre-existing Condition limitation. This waiver of Pre-existing Condition limitation will apply only if the Covered Person becomes eligible and enrolls for coverage within 63 days of termination of his or her prior coverage.

    Pre-existing Conditions limitations does not apply to: (a) a newborn Dependent child; or (b) a child adopted by the Covered Student or placed with the Covered Student for adoption, if adoption or placement for adoption occurs while covered under the Policy; or, (c) a foster child placed with the Covered Student while covered under the Policy.

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Disclaimer
This is only a brief description of the coverage available. The Policy on file at the University may contain reductions, limitations, exclusions and termination provisions. Full details of the coverage are contained in the Policy. If there is any conflict between the contents of this website and the Policy, the Policy shall govern. This Plan also covers Mandated Benefits as required by this state.