University of Hartford
Student Health Insurance Requirements
Table of Contents
Insurance program cost and
Insurance coverage highlights
Additional optional coverage - Dental and Vision care
Requesting a insurance "Waiver"
Who to contact
Medical Claim Form
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 student
Health Insurance Plan. We have partnered with
Gallagher Koster and the
United Healthcare Insurance Company
to provide this service to you. We
strongly advise that you do not purchase health insurance in your home country,
whether through your government, sponsoring agency, employer or private
insurance company. In most instances it will not meet the University of
Hartford's health insurance standards, which are compliant with the U.S. Federal
Health Care Reform Law known as the "Patient Protection and Affordable Care Act"
(PPACA). In addition, The University of Hartford will not accept "travel"
or "short-term" insurances polices which do not meet university health insurance
standards; you may be required to spend additional funds to purchase the
university policy or another policy that meets our standards.
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 $1,290 for both undergraduate and graduate international students for the
2013-2014 year. (see below for the current fee and schedule).
Insurance Fees and Schedule
International Student Rates
(09/01/2013 - 08/31/2014)
Fall Only Coverage
(09/01/2013 - 01/18/2014)
Insurance Coverage Highlights
$500,000 Maximum Benefit for each Injury or Sickness for Covered Medical
Deductible for Preferred Providers Per Insured Person, Per Policy Year, $200
Deductible for Out of Network Providers Per Insured Person, Per Policy Year.
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 Copays as described
in the policy).
Provider Out-of-Pocket Maximum of $5,000 Per Insured Person, Per Policy
Year. Out-of-NetworkOut-of-Pocket maximum of $10,000 Per Insured Person, Per
Policy Year. After the Out-of-Pocket Maximum has been satisfied, Covered
Medical Expenses will be paid at 100% up to the policy Maximum Benefit
subject to any applicable benefit maximums. Refer to the plan certificate
for details about how the Out-of-Pocket Maximum applies.
Prescription Drug Benefits: $15 Copay for generic drugs / $30 Copay for
brand name drugs/ $40 copay for brand name non-preferred drugs up to a
30-day supply per prescription filled at an Express Scripts Pharmacy
network. Mail order through Express Scripts at 2.5 times the retail Copay up
to a 90 day supply. $15 Deductible for generic drugs / $30 Deductible for
brand name drugs / $40 Deductible for brand name non-preferred drugs up to a
31-day supply per Prescription at an Out-of-Network pharmacy.
Care Services which include, but are not limited to annual physicals, GYN
exams, routine screenings and immunizations are covered at 100% with no
Copay or Deductible only when the services are received from a Preferred
available for eligible Dependents.
Preferred Providers for this plan are the UnitedHealthcare Options PPO.
FrontierMEDEX – Domestic Students are eligible for FrontierMEDEX services
when 100 miles or more away from your campus address and 100 miles or more
away from your permanent home address. International Students are covered
worldwide except in their home country.
available for University of Hartford students is a UnitedHealthcare
Insurance Company fully insured Dental plan, to enroll go to
coverage for intercollegiate sports injury is available provided under a
separate policy #2013-1057-8.
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
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 the number on your ID Card.
- 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.
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
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 health 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
2013 for those students enrolling the Fall 2013 semester and February 22, 2014
for those students enrolling in the Spring 2014 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
The requirement that you purchase the University
of Hartford Student Health Insurance Plan may be waived only if you meet certain
eligibility criteria and have comparable insurance that is valid in the
U.S. Only students who fit into one of the following categories are eligible for
an insurance waiver:
- Student funded by his or her government, or
the U.S. government.
- Student receiving health insurance benefits
provided by a U.S. employer of his or her parent, spouse or domestic
- Student enrolled at the University of
Hartford but doing studies or research outside the U.S.
- Student working in the U.S. and receiving
health insurance benefits through his or her employer.
- Student who has private health insurance
that meets the University's minimum standards
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 and approval of your Waiver request, 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):
Plan must be one year
Company must be U.S. based
and the address to submit claims must be in the U.S.
minimum coverage of at least
$500,000 per policy year
Deductible no greater than
$100 for preferred providers/Preferred Provider Out-of-Pocket Maximum of $5,000 per insured
100% with no co-payments
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
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" or "Travel" are not considered comparable coverage
Waivers for the 2013-2014 academic
year will be processed through the International Center. If the
International Center cannot determine whether a non-university
insurance policy meets specified requirements, the Center will consult with
Gallagher Koster to determine final Waiver eligibility.
The University DOES NOT recommend non-university
health insurance providers to its students. If you are Waived from the
University policy, it is your responsibility to insure that you have continued
coverage for the duration of the waived period and that your policy meets both
Federal and University requirements. The University assumes no
liability should you choose to waive the University's policy or discontinue your insurance coverage. If you
choose to discontinue a non-university insurance policy, you are required to
enroll in the University health care program and MUST inform the International
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
How to get a copy of your
Students that are enrolled in the University of Hartford program may download 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