Student Health Insurance 101 - University of Houston
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Student Health Insurance 101

It is very important to know about your insurance before you need it. Review your health insurance plan Summary of Benefits and check with your insurance carrier or administrator if you have specific questions concerning your benefits or enrollment.

Important Insurance Terms

Copay or Copayment

A fixed amount for a covered service, paid by the patient, to the providers of service before services are rendered.

Student Health Insurance Plan (SHIP): There is no copay required for Covered Medical Expenses when services are provided at the Student Health Center. Prescriptions filled at the Campus Pharmacy do require a pharmacy copay. All in-network Urgent Care visits, specialist, primary care visits outside of the Student Health Center are subject to a $35.00 copay for the office consultation. Any procedures, testing or extensive medical are subject to a $350.00 copay and coinsurance.

Deductible

The amount you pay for covered health care services before your insurance plan starts to pay.

Student Health Insurance Plan (SHIP): Deductible will be waived and benefits will be paid at 100% for Covered Medical Expenses incurred when treatment is rendered at the Student Health Center. All in-network Urgent Care visits, specialist, primary care visits outside of the Student Health Center are subject to a $35.00 copay for the office consultation. Any procedures, testing or extensive medical are subject to a $350.00 copay and coinsurance.

Coinsurance

The percentage of costs of a covered health care service you pay (for example, 20%) after you’ve paid your deductible.

Student Health Insurance Plan (SHIP): There is no coinsurance required for Covered Medical Expenses incurred when treatment is rendered at the Student Health Center. All in-network Urgent Care visits, specialist, primary care visits outside of the Student Health Center are subject to a $35.00 copay for the office consultation. Any procedures, testing or extensive medical are subject to a $350.00 copay and coinsurance.

Premium

The amount you pay for your health insurance.

Student Health Insurance Plan (SHIP): Go to Academic HealthPlans for premium cost.

Eligibility

This refers to whether or not you have met the requirements necessary to qualify for enrollment in the health care plan.

Student Health Insurance Plan (SHIP): UH Eligibility Requirements

Open Enrollment Period

The period of time when you can sign up for a health care plan.

Student Health Insurance Plan (SHIP): Go to Academic HealthPlans

Coverage Period

The time range that your health insurance plan is in effect.

Student Health Insurance Plan (SHIP):

Annual: September 1st – August 31st (Early enrollment option available for August 1st – August 31st)

Fall Only: September 1st – December 31st (Renewing Students)/August 1st – December 31st (New Students)

Spring/Summer: January 1st – August 31st

Summer Only: June 1st – August 31st

Summary of Benefits

A list of medical services and supplies a health insurance plan covers and costs. You should become familiar with your benefits or contact your insurance provider for more information.

Student Health Insurance Plan (SHIP): Go to Academic HealthPlans

Exclusions or Limitations

Specific conditions or circumstances for which a health plan will not provide or limits benefits. Common exclusions or limitations could include acupuncture, certain fertility treatments, cosmetic surgery, foot care, hair loss, and weight management. It is very important that you are aware of the exclusions and limitations of your health plan. If your health insurance plan does not cover a service or procedure, you are responsible for the full cost of these services. You can view the exclusions or limitations in your health care plan’s Summary of Benefits.

Student Health Insurance Plan (SHIP): Go to Academic HealthPlans.

Identification (ID) Card

This is your proof of insurance. You use it when you visit a healthcare provider. It also contains your insurance ID number, insurer’s name and contact number, the type of plan and payment options. You should keep this card with you as you would your driver’s license or other important identification.

Student Health Insurance Plan (SHIP): How to Obtain Insurance ID Card

Claim

A bill submitted to a health plan for payment.

Student Health Insurance Plan (SHIP): The Student Health Center and Campus Pharmacy will submit a claim on your behalf for any eligible expenses after services are rendered.

For services rendered outside of the Student Health Center, please check with the healthcare facility concerning how your claim will be handled.

Explanation of Benefits (EOB)

Each time a claim is filed, you will receive a statement that shows the date you received care, the name of the provider, the charge for each service, the amount the insurance paid, and the remaining balance which is your responsibility. EOB’s can be found online or mailed directly to you once a claim has been processed. If you have a question about what you owe or how the payment amounts were determined, please contact the Customer Service number listed on your insurance ID card.

Out of Pocket Maximum

The most you will have to pay for covered medical expenses in a plan year through deductible, coinsurance and copays before your insurance plan begins to pay 100% of covered medical expenses.

In-Network (or Network)

A fixed amount you pay for covered health care services to providers who contract with your health insurance or plan. In-network services are usually less than out-of-network copayments.

Out-of-Network (or Non-Network)

A fixed amount you pay for covered health care services from providers who do not contract with your health insurance or plan. Out-of-network services are usually more than in-network copayments.

Hospital

An institution where the sick or injured is given medical care. Check the Summary of Benefits for information about services rendered at the Hospital.

Student Health Insurance Plan (SHIP): Go to Academic HealthPlans to view the brochure of the Summary of Benefits.

Urgent Care Centers

These centers are convenient to use after hours such as when Student Health Services or doctor’s offices are closed during evenings and weekends. If medical attention is needed right away, but it is not necessary to visit an emergency room, this is a reasonable option. The cost of an urgent care visit may be more costly than a doctor's visit. It is important that you use an in-network provider. Check the Summary of Benefits for information about services rendered at an Urgent Care Center.

Student Health Insurance Plan (SHIP): Go to Academic HealthPlans to view the brochure of the Summary of Benefits.

Emergency Rooms

Only use an emergency room when you have a true emergency and require immediate medical attention. They are not to be used for non-emergency conditions. Examples of true emergencies are life-threatening issues, such as chest pain, non-stop bleeding, and loss of consciousness. Check the Summary of Benefits for information about services rendered at an Emergency Room.

Student Health Insurance Plan (SHIP): Go to Academic HealthPlans to view the brochure of the Summary of Benefits.

TeleHealth

Remote access to medical doctors or counseling services.

Student Health Insurance Plan (SHIP): TeleHealth services are available. Go to Academic HealthPlans for information.

Preferred Provider Organization (PPO)

By staying in your PPO network, you may have access to negotiated rates, lower out-of-pocket costs and benefits for out-of-network care at any time (although your level of coverage and benefits may be reduced). It is not necessary to have a primary care doctor or consult a specialist.

Usual and Customary (U&C)

Usual and Customary means the average charged by most providers for treatment, services or supplies in the geographic area where the treatment, service or supply is provided. However, most non-PPO providers costs are over and above usual and customary and therefore, you would be responsible for any cost over U&C in addition to your coinsurance and/or deductible/copays.