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UC
Student Health Insurance Plan
2015-16
Plan Year Waiver Criteria
I. To satisfy UC¡¯s 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
OR
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
sports
4) not be a health care reimbursement
arrangement with the student¡¯s home country or another
party.
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
student¡¯s
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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