Student Health Insurance Information & Forms
Fall 2012 Open Enrollment for UA’s Voluntary Student Health Plan starts 8/1/2012 and ends 8/31/2012
UnitedHealthcare Student Resources (UHCSR) is the underwriter for both the voluntary student health insurance plan 2012-328-1 and for the voluntary GA/fellowship student health insurance plan 2012-328-4 offered by the University of Alabama. Both of these voluntary UHCSR student health insurance plans provide $250,000 in coverage per insured person for the 2012-2013 plan year. Therefore, they exceed the minimum $100,000 in coverage per insured person required by the health care reform law for the 2012-2013 plan year.
To be eligible for the 2012-328-1 student health plan, UA undergraduates must be enrolled in at least six credit hours per semester on campus. To be eligible for the 2012-328-4 plan, UA graduate students must be enrolled in at least three credit hours per semester on campus. Call the Student Health Insurance Center at (205) 348-4086, if you have any questions about how to enroll in the student health insurance plan, but please read all of the following before calling.
UA’s Voluntary Student Health Plan for 2012-2013 is for the following students:
1. Domestic Undergraduate Students, non-GA Graduate Students, and non-qualifying GA Graduate Students with NO health insurance benefits can enroll in UHCSR’s student health insurance policy 2012-328-1
Domestic undergraduates and non-GA graduate students who choose to enroll in the UHCSR student health insurance for coverage effective for 8/16/2012-12/31/2012 can enroll directly through UHCSR’s website starting 8/1/2012 and must pay the required Fall 2012 semester premium with a credit card for coverage to begin or they can complete the attached “2012-2013 VOLUNTARY ENROLLMENT FORM FOR DOMESTIC STUDENTS AND THEIR DEPENDENTS” and mail that enrollment form into UHCSR with the required premium payment before 8/31/2012. NOTE: Insurance coverage begins only when the completed enrollment form and required premium payment is received by UHCSR.
- Enroll directly at UHCSR website at uhcsr.com
- 2012-2013 Voluntary Enrollment Form for Domestic Students and Their Dependents
- 2012-2013 Authorization to Disclose Health Records to Your Insurance Provider
2. International and/or English Language Institute (ELI) Students will be enrolled in UHCSR’s policy 2012-328-4 as explained below.
All international students will be automatically enrolled in the UHCSR student health plan by The University of Alabama unless written proof of current comparable health insurance is provided to the University of Alabama. If they already have current comparable health insurance coverage, then the International student must secure a signed “waiver of coverage form” from that other health insurance company and provide that signed form to The University of Alabama Student Insurance Office located on campus at the Student Health Center in Tuscaloosa, Alabama before 8/31/2012.
All English Language Institute (ELI) students must contact the English Language Institute on UA campus via e-mail at info@eli.ua.edu or call (205) 348-7413 before 8/31/2012 about their student health insurance requirements, costs and deadlines.
- UHC 2012-2013 Enrollment Form for Dependents of International Students
- 2012-2013 Authorization to Disclose Health Records to Your Insurance Provider
3. Qualifying Graduate Assistants (GA, GTA, GRA, or Fellowship) I.e. those who will qualify for health insurance benefits through the University of Alabama for UHCSR plan 2012-328-4
All UA approved and qualifying graduate assistants and fellowship students are eligible for single health insurance with a full or a partial subsidy paid by The University of Alabama to United Healthcare Student Resources, but the student MUST complete the 2012-2013 Graduate Assistant Enrollment Form (see below) and submit the completed and signed form directly to the Student Health Center prior to 8/31/2012 for coverage to begin from 8/1/2012-1/31/2013 (6 months).
Registration by GAs, GTAs, GRAs and Fellowships for the subsidized student health insurance cannot be accepted after 8/31/2012.
If you are unsure of whether or not your graduate assistantship or fellowship is eligible, please contact your supervisor or the department administering your assistantship or fellowship.
- 2012-2013 Graduate Assistant Enrollment Form
- 2012-2013 Enrollment Form for Dependents of Graduate Assistants
- 2012-2013 Authorization to Disclose Health Records to Your Insurance Provider
Other Forms/Handouts
- UHCSR 2012-2013 Student Health Insurance Benefit Summary for policy 2012-328-1
- UHCSR 2012-2013 Student Health Insurance Benefit Summary for policy 2012-328-4
- 2012-2013 Student Health Insurance Brochure
- 2012-2013 Authorization to Disclose Health Records
- Waiver form for International Students
- Continuation Forms
NOTE: Only UA students previously enrolled in UA’s student health plan with United HealthCare Student Resources (UHCSR) in the Summer of 2011 or who enroll in the Fall 2011 or Spring 2012 and then lose that coverage are eligible to enroll for extended continuation coverage with UHCSR for an additional 1 to 6 months, if additional premiums are paid.
For students who are enrolled in UnitedHealthcare Student Resources health plan, a referral from the SHC for outside medical care is not necessary under the following conditions:
- Medical Emergency
- When SHC is closed
- When service is rendered at another facility during break, holidays or vacation periods
- When medical care is received by the student more than 50 miles away from campus
- When student is no longer a student due to change in status (like graduation)
- Psychotherapy does not require a referral
However, if you do receive medical care from a medical provider outside the SHC without a referral for any other reason than those listed above then UnitedHealthcare Student Resources can pay the outside medical provider at 60% of the out-of-network (OON) level.
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