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KAKAO ID : life5050


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Emporia State University







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2015-2016  Waiver Criteria




Health Insurance

Kansas Board of Regents policy states Each state university shall require any international student holding a F-1 visa and any exchange visitor holding a J-1 visa to show proof of health insurance coverage for each semester or term for which the student is enrolled, whether or not the student is participating in the Boards voluntary student health insurance program. Such proof of insurance shall be required prior to the student beginning classes.

All international students must meet the requirements of the KBOR Student Health Insurance Plan. If you elect not to use the KBOR plan you must waive out of this coverage. You must complete and return this waiver form along with proof of adequate health insurance coverage from another health plan that meets KBORs requirements. New waiver requests must be submitted EVERY semester for which the student is enrolled. Even though you are required to be covered the first day of class, we recommend that your coverage begins immediately upon you arrival in the U.S.  If you purchase the KBOR approved policy from United Healthcare you will be covered from August 1, 2013 through December 31, 2013. This policy will cover the tuberculosis (TB) blood test and Meningitis (meningococcal) vaccination for new international students.

You may purchase the KBOR approved policy online in advance at www.uhcsr.com/emporia. You may also find the complete United Healthcare brochure on this page.

Students will not be able to enroll or pay tuition at ESU until showing proof of active and adequate health insurance.


Health insurance coverage requirements

Your insurance plan must meet the following required benefits and coverage.

  • A minimum of $500,000 annual coverage with no lifetime aggregate limit (no per incident maximums).
  • Coverage for essential benefits as defined under Patient Protection and Affordable Care Act – including pharmacy, mental health, maternity, preventive care, contraception – with no dollar limits.   
  • A pre-existing conditions exclusion waiting period that is reasonable (9 months or less).
  • A policy year deductible of $500 or less.  Total maximum out of pocket expense (deductible plus out-of-pocket maximum) cannot exceed $7,500.
  • A minimum of $10,000 for repatriation and $15,000 for medical evacuation.
  • A minimum of 70% coinsurance payable by the insurance plan to network providers. Emergency/urgent care only is not accepted for waiver.
  • Verifiable proof of coverage with students name (ID card, insurance policy or letter from insurance carrier – copy provided).
  • Effective dates covering the entire period for which I am requesting a waiver.
  • Plan document(s) in English, with currency amounts converted to U.S. dollars, and an insurance company contact phone # in the U.S.
  • Insurer has a base of operations in the U.S. or has a U.S. based claims payer.

Please make sure that your insurance benefit statement is printed in English and U.S dollars, meets the requirements and is ready to present to office personnel during the first day of the International Student Orientation. Failure to comply with this requirement will result in delays in your enrollment process




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8/01/15 – 7/31/16














Insurance  Provider








Aggregate Maximum















Plan year deductible 


In-Network: $300

In-Network: $100

Out-of-Network:     $600      


Out-of-Network:  $300      





In Network : 80%






Out of  Network:60%














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