Waiver Submission Minimum Requirements Checklist

The waiver department at Academic HealthPlans will audit all submitted waiver request documentation based on the University of Houston System Policy for International Student Health Insurance Requirements. The following is an example of the multi-section checklist that is used.

If the waiver department determines during the audit of the waiver submission documentation that the alternate health insurance policy does not meet the minimum requirements, documentation cannot be verified or that additional information is needed to verify the waiver submission, the waiver will be denied and no further review of the currently submitted documentation will be completed at that time.

An email notification advising the student will be sent. The email will include the reason for the denial and instructions about how to submit additional information, if applicable.

Section One

Was a scanned copy of the following documentation uploaded with your waiver submission?
The answer must be YES to all the following questions or the waiver submission will be automatically denied without further review.

· Was a scanned copy of the front and back of the alternate insurance ID card uploaded?

· Was a scanned copy of the policy benefit document uploaded? Is the alternate health insurance plan documentation in English and in US currency/dollars? If applicable, was a sponsorship letter included?

· Is the documentation of the alternate health insurance plan provided by a company licensed to do business in the United States and include a U.S. claim office address/U.S claims phone number?

Section Two

Does the student's alternate health insurance plan meet the following criteria?
The answer must be YES to one of the following criteria or the waiver submission will be automatically denied without further review.

· The student is sponsored by the U.S. government, the government of the student's home country if recognized by the U.S. or by certain international, government-sponsored or non-governmental organizations, and if the sponsor has provided a plan equivalent to the SHIP or a letter guaranteeing payment of all health care expenses?

· The student is enrolled in an employer-provided group health plan that is equivalent to the UHS-endorsed Student Health Insurance Plan?

Section Three

Does the alternate health insurance plan meet all of the following requirements?
The answer must to YES to all of the following questions or the waiver submission will be automatically denied without further review.

· Does the alternate health insurance plan include medical/preventative care benefits equivalent to the UHS-endorsed Student Health Insurance Plan with no annual limits?

· Does the alternate health insurance plan contain no exclusions for pre-existing conditions?

· Does the alternate health insurance plan impose no provisions for co-insurance that exceeds 25% of the covered benefit?

· Does the alternate health insurance plan include dates of coverage that meet or exceed the requirement for the SHIP coverage period and can active coverage be verified?

Fall: August 1st – December 31st
Spring/Summer: January 1st – August 31st
Summer Only: June 1st – August 31st

Section Four

Is the alternate health plan one of the following?
The answer must be NO to all of the all of the following options or the waiver submission will be automatically denied without further review.

· An individual/family plan purchased directly from HealthCare.gov, other government service organization or an insurance company.

· A travel plan.

· A Healthcare Spending Account.

· A Healthcare plan that do not cover the full requirements listed on the waiver requirement.

Section Five

Does the alternate health insurance plan meet the deductible requirements?
The answer must to YES to the option applicable to the student's visa status or the waiver submission will be automatically denied without further review.

· If the student holds a J visa, does the alternate health insurance plan impose a deductible that does not exceed $500 per year?

· If the student holds a F visa, does the alternate health insurance plan impose a deductible that does not exceed $1500 (individual)/$3000 (family) per year?

Section Six

Does the alternate health insurance plan include the minimal amount of medical evacuation and repatriation coverage?
If medical evacuation and repatriation that equals the amounts as compared to the SHIP are not included in an otherwise acceptable policy, a rider must be purchased. If the answer to any of the following questions is NO, the rider must be purchased. An Academic Emergency Services (medical evacuation and repatriation) policy can be purchased on the Academic HealthPlans website during the Open Enrollment Activation and Waiver Period.

· Was documentation of the a medical evacuation and repatriation plan provided or the Academic Emergency Plan purchased?

· Does the alternate health insurance plan provide medical evacuation coverage in the amount of no less than $50,000,?

· Does the alternate health insurance plan provide repatriation coverage in the amount of no less than $25,000?

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