University of Hartford
Injury and Sickness Insurance Requirements
Table of Contents
Insurance program cost
Insurance coverage highlights
Insurance cost and schedule
Requesting a waiver
Who to contact
Non University Insurance
How to get a copy of your
University of Hartford requires all undergraduate and graduate full and
part-time international students on an
visa or a J-1/J-2 student exchange visitor visa to be enrolled in an injury and sickness insurance program. Students will
be required to participate in the University of Hartford's Injury and Sickness
Insurance Plan. We have partnered with
Gallagher Koster and the
United Healthcare Insurance Company
to provide this service to you.
Changes to the
previous university-sponsored plan will occur in the 2012-13 academic year due to
new health insurance requirements mandated under the
Patient Protection and Affordable Care Act recently enacted by the U.S.
government. Student health insurance plans must now comply with the new
requirements. Policy fees will increase from previous years. Benefits
of this plan are greater and now include wellness and prescription coverage, an increase
of coverage from $25,000 to $100,000 for each injury or sickness, available
coverage for dependents and other benefits.
Insurance Program Cost
cost of this plan will automatically be added to your university billing charge
at the time of your course registration each semester. The
University estimates the cost of this insurance to be $1,117 for both undergraduate and graduate international students for the
2012-2013 academic year. (see below for the current fee and schedule)
The University has put in place a
"waiver" process for qualifying F and J students. While insurance is required, a
student may request a "waiver" from the University administered insurance
program by showing that they are already enrolled in a program which
has coverage equal to or greater than the University policy.
Qualifying students must request a waiver through the International Center.
Waivers must be requested no later than the University's "Census Date" (October
2012 for those students enrolling the Fall 2012 semester and February 22, 2013
for those students enrolling in the Spring 2013 semester.) Students requesting a
waiver after the "Census" date will be denied their request for a waiver for
that semester and billed for the University insurance policy. A decision on a request for
a waiver will be made within five working days or less by the International
Center. (See instructions below on how to Waiver the University of Hartford
Highlights of the Coverage and Services offered by United Healthcare:
Up to a $100,000 per each Injury or Sickness per policy.
$100 deductible for Preferred Providers, $200 deductible for
Out-of-Network Providers, per Insured Person per Policy Year.
Deductibles and co-pays are waived when using Student Health
Services (SHS). For this policy: Expenses at SHS are billed directly to the
Insurance company. No out of pocket payment required by student
$5,000 Out-of-Pocket maximum for Preferred
Providers, $10,000 Out-of-Pocket maximum for Out-of-Network providers per
Insured Person per Policy Year. Refer to the brochure for details about how
the Out-of-Pocket maximum applies.
The Preferred Provider is the UnitedHealthcare Options PPO
Medical Expenses for Preferred Providers are payable at 80% of Preferred
Allowance and Out of Network benefits are payable at 60% of Usual and
Customary charges (all benefits are subject to satisfaction of the
deductible, specific benefit limitations, maximums and co-pays as described
in the policy).
Pre-existing conditions do
not apply for students 19 or under
Network Prescription Drug Benefit at UHPS (Medco) pharmacies:
$15 co-pay per prescription for Tier 1/$30 co-pay per prescription for Tier
2/ $50 co-pay for Tier 3 up to a 31-day supply per prescription. The
Prescription Drug Benefit is also available at Out-of-Network pharmacies.
Oral contraceptives covered at 100%, no copayment. Prescriptions are covered
up to the policy maximum.
Preventive Services benefit which includes annual physicals,
GYN exams, routine screenings and immunizations, covered at 100%, no co-pays
or deductibles to Preferred Providers only. Please refer to
for complete details of the services provided for specific
Coverage available for eligible dependents including Domestic
Scholastic Emergency Services – International Students
are covered worldwide except in their home country.
The University of Hartford insurance
program also offers coverage for a spouse or child(ren) at an additional cost.
Dependents of an F-1 student are not required to have injury and sickness
insurance coverage (unless enrolled as a full or part-time student), though the University strongly recommends coverage be
purchased, particularly for a child(ren). Dependent(s) of a J-1 exchange visitor
student must carry insurance that meets
U.S. Department of State requirements
(the university policy meets or exceeds these requirements).
Note: An F-2
dependent who is enrolled as a student must have the required insurance
Insurance Fees and Schedule
International Student Waiver Rates
Fall Only Coverage
Additional Optional Coverage
Dental Plan Coverage (Basix
Dental Savings and Wellness)
The cost of dental care is a major concern to
both students and health service administrators. To help with this issue,
Gallagher Koster makes the Basix Dental Savings Program available to you. It is
important to understand the Dental Savings Program is not dental insurance.
Basix contracts with dentists that agree to charge a reduced fee to students
covered under your Gallagher Koster plan. The student must pay for the services
received at the time of service to receive the negotiated rate.
Savings vary but can be as high as 50% depending
upon the type of service received and the specific contracted dentist providing
the service. To use the program, simply:
- Make an appointment with a contracted
dentist; all the contracted dentists are listed on our website,
- Make sure the dental office understands that
you have access to the Basix program. We list an administrative contact
person for each dentist to help clear up any confusion on the spot. We don't
issue a separate identification card for the Basix program. The dentist's
office may ask for your health plan identification card to make sure you
have access to the program. If the office needs to check eligibility, call
Gallagher Koster at 877-320-4347.
- Remember, you must pay for the services you
receive at the time of service, so make sure you understand what forms of
payment (check, credit card, etc.) the dentist accepts.
Eye Vision (EyeMed Vision
This discount vision plan is available through
EyeMed Vision Care. EyeMed's provider network consists of over 45,000
independent providers and retail stores nationwide, including LensCrafters,
Pearle Vision, Sears Optical, Target Optical, JC Penney Optical, and many
This is not an insurance plan; there is no
waiting period. Enrolled students can take advantage of the savings through
EyeMed immediately upon receipt of their separate ID card. You can purchase
prescription eyeglasses, conventional contact lenses or even non-prescription
sunglasses at savings between 15% and 45% off regular retail pricing. In
addition, you can receive discounts from 5% to 15% off laser correction surgery
at some of the nation's most highly qualified laser correction surgeons.
Please click on the following link to download
Please click on the following link to print an
EyeMed ID Card:
EyeMed ID Card.
To locate a participating provider, or if you
have any additional questions, you can call 1-866-8EYEMED or go online at
How to request a Waiver
Complete a University Insurance
Bring your waiver form and insurance policy coverage document to
the international Center (an insurance ID card is not acceptable as the
university is required to determine that your policy meets specific
insurance limitations and coverage)
Upon receipt of your Waiver request and
supporting documentation, the
International Center will update your University account with the Bursar's
Office. The charge for insurance will be removed from your account and
that information will be sent to
should meet these minimum requirements to be eligible for a Waiver (other
requirements may be applicable):
Policy must be one year
Company must be U.S. based
and the address to submit claims must be in the U.S.
Plan maximum of at least
$100,000 per policy year
Deductible no greater than
100% with no copayments
No internal benefit caps on
coverage categories (diagnostics, lab, hospital, R&B, pharmacy, mental
Travel assistance for
medical evacuation and repatriation
coverage after 6 months to one year
No waiting periods for
pre-existing conditions for students 19 or younger
A private insurance policy must be issued from a
U.S. based company. Insurance policies issued to you from non U.S. based
insurance companies will not be accepted. Insurance policies issued
for short-term coverage are not considered comparable coverage
Waivers for the 2012-2013 academic
year will be processed through the International Center. In future years,
students will request waivers directly on-line through Gallagher Koster.
Who to Contact
Questions regarding this insurance policy (including coverage limitations) should be addressed to
or the International Center (GSU 327). You may view the
Policy Coverage Limitations and
Frequently Asked Questions information document at these sites.
Medical Claim Form
You may download a copy of the
Medical Claim Form here
does not recommend non university Injury and Sickness policies to
students. However, to assist you in finding other policies that meet minimum
government requirements, we have identified the company below as meeting the
requirements of the "Affordable Care Act." You may also do a Google search (type in
international student insurance) to find more providers offering international
student insurance coverage:ISO Student Health Insurance
Note: The University
assumes no responsibility in recommending outside insurance providers and is
only responsible in assessing the coverage of any outside policy you choose to
determine if it meets university and government requirements for coverage.
How to get a copy of your
Those that are enrolled in this program may also get a copy of their insurance
card and policy information through our insurance company’s website.
Here are instructions on how to
Step 1: Go to the link:
Step 2: Create an account
Step 3: Go to Authorize Account
and sign in using your University of Hartford student ID and birth date.
Step 4: Print out your