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KAKAO ID : life5050


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University of California San Fransisco



syracuse university  




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UC Student Health Insurance Plan

2015-16 Plan Year Waiver Criteria


I.  To satisfy UCs health insurance requirement for enrolled students, the plan held by the student must:

1)  Be a Medi-Cal, Medicare or Tricare/military insurance policy or a Covered California plan


2)  Be an employer-sponsored group health plan or  individual plan that meets the following criteria:

a.  Has unlimited lifetime benefits

b.  Has an annual out-of-pocket maximum of up to $6,600 for an individual but no more than

$13,200 for a family.  Deductibles, copayments and coinsurance paid by the member accrue

toward meeting the out-of-pocket maximum.  A higher out-of-pocket maximum is allowed if

the subscriber has a Health Savings Account (HSA) or a Health Reimbursement Account (HRA)

c.  Covers the following services (ACA Essential Health Benefits):

i.  Preventive health care services, including an annual physical exam, preventative

immunizations and laboratory/diagnostic tests to help determine your state of health

ii.  Chronic disease management for such conditions as asthma, diabetes or other chronic

medical conditions

iii.  Hospital stays for medical and surgical care

iv.  Hospital stays for mental health and alcohol/drug abuse conditions, covered the same

as any other medical condition

v.  Doctor office visits for medical, mental health, and alcohol/drug abuse conditions

vi.  Emergency room services

vii.  Diagnostic services including laboratory tests

viii.  Medications prescribed by a doctor (including contraceptives)

ix.  Pre-natal and maternity care, with no pre-existing condition limitation


II.  For international students, the following additional criteria apply.  The plan must:

1)  have no pre-existing condition exclusion;  if the plan has a pre-existing condition waiting period,

that period has expired

2)  have no per-injury or per-illness maximum benefit limits

3)  cover medical services for injury from participation in all types of recreational activities or amateur


4)  not be a health care reimbursement arrangement with the students home country or another


5)  have policy written in standard English with benefits expressed in U.S. dollars

6)  have a claims payment office with an address in the United States

7)  pay at least $50,000 annually for medical evacuation

8)  pay at least $25,000 for repatriation of remains


III.  Finally, all plans must provide unrestricted access to an in-network hospital or doctor providing full,

non-emergency medical and behavioral health care within reasonable distance of campus or the

students place of residence while attending school.  Such distance shall be determined at the

discretion of each campus based upon its unique geographic considerations and local availability of

services. (The waiver form will indicate the distance requirement appropriate for each campus.) 

NOTE: this criterion applies to all plan types, including Covered California plans.








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2015 91 - 2016831







98   ĥ shs@ucsf.edu л ǰ

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$ 73.00   û ֽϴ.








Insurance  Provider





Aggregate Maximum















Plan year deductible 











In Network : 90%






Out of  Network:60%





б п  $1.355


1 Student:$1,045





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New York University
University of California, Riverside