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University of North Florida
insurance waiver º¸Çè Á¶°Ç
1. Coverage Period: Coverage must include the academic year from the third week of August to the following
third week of August. Policy must provide continuous coverage for
the entire period the insured is enrolled as an eligible student,
but may be broken down into semesters. UNF requires that the students be covered from the first day of class
until the last day before the next semester begins each semester the student is registered for classes.
Payment of benefits
cannot be limited to a specific period of time (i.e., must be renewable). NOTE: For students graduating in the
fall term, coverage must extend through the first week of January, when the coverage period ENDS.
15. Policy provisions must be available from the insurer in Eng
2. Basic Benefits: Room, board, hospital services, physician fees, surgeon fees, ambulance,
outpatient services, and outpatient customary fees must be paid at 80% or more of usual, customary,
reasonable charge per accident or illness, after deductible is met, for in-network, and 70% or more of usual,
customary, and reasonable charge for out-of-network providers per accident or illness.
3. Inpatient Mental Health Care: Must be paid at 80% in-network or 60% out-of-network of the usual and
customary fees with a minimum 30-day cap per benefit period.
4. Outpatient Mental Health Care: Must be paid at 80% in-network or 60% out-of-network of the usual and
customary fees for a minimum of 30 (preferably 40) sessions per year.
5. Maternity Benefits: Must be treated as any other temporary medical condition and paid at no less
than 80% of usual and customary fees in-network or 60% out-of-network.
6. Inpatient/Outpatient Prescription Medication: Must include coverage of $1,000 or more per policy year.
7. Repatriation: $25,000 (coverage to return the student¡¯s remains to his/her native country).
8. Medical Evacuation: $50,000 (to permit the patient to be transported to his/her home country and to be
accompanied by a provider or escort, if directed by the physician in charge).
9. Exclusion for Pre-Existing Conditions: First six months of policy period, at most.
10. Deductible: Maximum of $50 per occurrence if treatment or services are rendered at the
Student Health Center; maximum of $100 per occurrence if treatment or services are rendered at
an off-campus ambulatory care or hospital emergency department facility.
11. Minimum coverage: $100,000 for covered injuries/illnesses per policy year.
12. Insurance Carrier must have an ¡°A¡± rating or above per Part 62.14(c)(1) of Section 22 of the
Code of Federal Regulations.
13. Policy must not unreasonably exclude coverage for perils inherent to the student¡¯s program of study.
14. Claims must be paid in U.S. dollars payable on a U.S. financial institution.
15. Policy provisions must be available from the insurer in Eng
insurance waiver form
http://www.unf.edu/shs/Immunization.aspx
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