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Student Health Insurance Requirements, 2019/2020 Academic Year

Mandatory Coverage

Maintaining comprehensive health insurance coverage is mandatory for all full-time WesternU students, and all students MUST be covered by an ACA compliant domestic health insurance plan for the entire academic year, including summer and holidays. All full-time WesternU students are required to enroll in the Student Health Insurance Plan unless an acceptable Waiver is provided by the designated deadline. 

Part-time WesternU students, those enrolled in programs where the entire curriculum is delivered online and students only enrolled in thesis/dissertation continuous registration courses are exempt from the University’s comprehensive health insurance requirement. However, all WesternU students may enroll in the student health insurance plan, regardless of their exemption status.

There are many insurance options available in the marketplace today. We encourage you to research your health insurance options thoroughly prior to making a final decision. For those of you unfamiliar with insurance terminology, HealthCare.gov provides a glossary of health insurance terms that may be helpful as you review and compare your insurance options.

Automatic Fee Assessment

All full-time WesternU students will automatically be assessed the fall 2019 premium for the student health insurance plan during fall 2019 registration. The fall 2019 premium charge will only be reversed upon receipt of an acceptable waiver by the posted waiver deadline. If an acceptable waiver is not received by the posted waiver deadline, your enrollment in the student health insurance plan will be finalized, you will no longer be eligible for a refund of the fall 2019 premium, and your student account will automatically be assessed the applicable spring 2020 premium during registration for the spring 2020 term.

The student health insurance plan for the 2019/2020 academic year is offered through Aetna Student Health and administered by Health Sciences Assurance Consulting (HSAC). Additional information on the benefits offered under the student health insurance plan, can also be found on the Health Sciences Assurance Consulting (HSAC) website.

Plan details include:

  Preferred Provider Organization (PPO) Non-Preferred Provider Organization (Non-PPO)
Deductible $250.00 $250.00
Co-Insurance 80% 60%
Out of Pocket Maximum (Individual) $6,350.00 $10,000.00
Out of Pocket Maximum (Family) $12,700.00 $20,000.00
Office Visit $20.00 Co-payment, 80% $20.00 Co-payment, 60%
Urgent Care Visit $20.00 Co-payment, 80% $20.00 Co-payment, 60%
Emergency Room Visit $200.00 Co-payment (Waived if Admitted) $200.00 Co-payment (Waived if Admitted)
Prescription Drugs $15.00/$25.00/$45/00 $15.00/$25.00/$45/00
If you wish to enroll in the student health insurance plan for the 2019/2020 academic year, you must submit your enrollment via the Health Sciences Assurance Consulting (HSAC) website. If you are a continuing student and are currently enrolled in the student health insurance plan during the 2018/2019 academic year, you will not need to resubmit your enrollment request.  Your coverage on the WesternU student insurance plan will continue for 2019-2020 unless a waiver is received and approved by your waiver deadline The earlier you submit your enrollment, the sooner you will receive your plan materials (brochure, ID card). Students enrolling after the plan begins will have their coverage backdated to the start of the plan unless they have experienced an involuntary loss of coverage.

The student health insurance plan is sold as an academic year plan; however, the premium is split into two equal payments. The first payment is assessed during fall 2019 registration, and the second payment is assessed during spring 2020 registration. Students who enroll in the student health insurance plan at the start of the academic year will remain enrolled for the entire academic year and will not be eligible to waive out of the plan during the spring term.

Students who are receiving financial aid may be eligible for a budget increase to cover the costs of the student health insurance plan premiums. For more information on eligibility and the process for increasing your budget, please contact the Office of Financial Aid at 909-469-5353 (Pomona campus) or 541-259-0360 (Lebanon campus). You can also e-mail the Office of Financial Aid at finaid@westernu.edu.

Students enrolling in the WesternU student insurance plan from 06/01/2019 – 07/31/2019 will be enrolled on the 18-19 policy year until 07/31/2019.  Your enrollment will continue in the 19-20 Policy year effective 08/01/2019.  Deductibles and Out-of Pocket Max requirements for care received from 06/01/2019 – 07/31/2019 will apply to the 18-19 Policy year.  Deductibles and out of Pocket Max reset effective 08/01/2019 and care received from 08/01/2019 – 7/31/2020 will apply to the 19-20 policy year.

Dependent Coverage

Qualified dependents can be added to the student health insurance plan. The coverage dates and rate would be the same as the student’s coverage dates and rate; however, the premium cannot be charged to your student account. The entire premium for dependents is due at the time of enrollment. You will be able to add dependents when you enroll in the plan or due to a qualifying life event (involuntary loss of coverage, birth or adoption).

Obtaining Your Student Health Insurance Plan Materials

Once you have enrolled in the student health insurance plan, you can access your insurance plan ID card, search for providers, view claims information and review benefits via the Aetna Student Health website.

Plan Premiums

Insurance Coverage Period Fall 2019 Premium Spring 2020 Premium Annual Premium
06/01/2019 – 07/31/2020 (MSMS 2020) $2,130.50 $2,130.49 $4,260.99
06/01/2019 – 07/31/2020 (ISAC 2023 – DO, DONW, DPM) $2,130.50 $2,130.49 $4,260.99
       
07/01/2019 – 07/31/2020 (IPBP 2022) $1,986.65 $1,986.65 $3,973.30
07/29/2019 – 07/31/2020  (CGN – Pre-Program Participants) $1,847.59 $1,847.59 $3,695.18
08/01/2019 – 07/31/2020 (All Other Student Groups) $1,838.00 $1,838.00 $3,676.00
01/01/2020 – 07/31/2020 (MSBS, MSHS, MSPS Spring Starts) N/A $2,134.84 $2,134.84
03/01/2020 – 07/31/2020 (DMD-IDP 2022) N/A $1,540.71 $1,540.71

*All insurance coverage is subject to applicable state form and rate filing approval and, once approved to the terms of the Master Policy. We have not yet received approval from the state insurance department for the 2019-2020 benefits and rates described in this document. As part of the approval process, the State may require us to make changes to the benefits and/or rates. We will notify you if that happens.

If you have active health insurance with benefits that meet all the criteria listed below, you may apply for waiver of enrollment in the WesternU plan. You will need to have your current insurance ID card and information regarding your plan benefits to complete the process. A copy of the front and back of your Health Insurance ID card must be submitted with your request. Once you have submitted the required information, you will receive an email verifying if your waiver meets the WesternU requirements. Waivers will not be accepted past the required deadline.

Acceptable Waivers

All full-time students MUST be covered by an ACA compliant domestic health insurance plan for the entire academic year, including summer and holidays.

The acceptable coverage to waive the WesternU – Sponsored Student Health Insurance Plan is a parent’s employer group plan, a spouse’s employer group plan, a student’s own employer group plan, VA Benefits or COBRA. Individual Plans will be accepted for the 2019-2020 Policy year as long as they meet the University’s waiver requirements.Additionally, the University will allow students to waive out of the student health insurance plan using Medicaid based coverage that originates in the state of California (Pomona campus students) or the state of Oregon (Lebanon campus students). The University will not approve any other state’s Medicaid coverage as an acceptable waiver, subject to the Distance Education Program exception below.

Distance Education Program Exceptions: Students participating in distance education programs such as those offered by the College of Graduate Nursing or the DPT (Post-Professional) program may waive out of the student health insurance plan using Medicaid based coverage that originates in the state in which they currently reside.

In order to waive out of the student health insurance plan, your deductible MUST NOT be more than $1,000 individual or $2,000 family annually, NO Exceptions.Your plan must provide adequate major medical coverage of at least $1,000,000/policy year, that includes prescription and mental health coverage as well as coverage for an annual exam. In addition, your plan must utilize a provider network in the area of the campus you are attending for primary care, specialty, hospital, and diagnostic care. Students attending online programs, including those that are only partially online are exempt from the provider network requirement.

Limitations Regarding Out of State Rotations/Clinical Experiences: California or Oregon based students who waive out of the student health insurance plan using their respective state’s Medicaid based coverage may only be eligible for coverage of emergency services while completing clinical rotations/experiences out-of-state. Some of the University’s out-of-state clinical rotation/experience sites may require that you have comprehensive health insurance coverage; therefore, you may not be eligible to attend certain clinical rotation/experiences using Medicaid based coverage. Students using Medicaid based coverage while completing a clinical rotation/experience out-of-state are responsible for all medical expenses incurred that are not covered by their Medicaid based plan. Graduating students completing clinical rotations/experiences out-of-state that match to an out-of-state residency program during their final year should note that their out-of-state placement may cause them to lose eligibility for their respective state’s Medicaid based coverage.

Short-term health insurance policies, traveler’s plans, or plans originating outside of the United States will not be accepted as part of the Waiver process.

If an acceptable waiver is not received by the posted waiver deadline, your enrollment in the student health insurance plan will be finalized, you will no longer be eligible for a refund of the fall 2019 premium, and your student account will automatically be assessed the applicable spring 2020 premium during registration.

Health insurance plans approved during the waiver process will be verified periodically to ensure students remain in compliance with the University’s health insurance coverage requirements.

To ensure that health insurance coverage requirements are met, all full-time students are automatically assessed for half of the annual student health insurance premium upon registration for fall. This fee is reversed only if you submit proof of health insurance coverage that meets the University’s coverage requirements. When you fail to submit proof of alternative health insurance coverage by the deadline for your program/class year, your enrollment in the student health insurance plan is finalized. In addition, you are no longer eligible for a refund of the first half of the premium and you will automatically be assessed the second half of the premium upon registration for the spring term.

Waiver Appeals

If your waiver is denied, you may appeal the decision. The University will only override the waiver denial if you meet one or more of the following criteria: • As the student you are enrolled on a parent, guardian or spouse’s health insurance plan and the responsible party signs the High Deductible Appeal Form on your behalf. • You can provide documentation (current statement) of a health savings account that holds a balance that will cover the difference between your health insurance plan deductible and the University’s $1,000.00 deductible requirement. Instructions and deadlines for submitting your waiver appeal will be provided in your waiver denial e-mail.

Periodic Waiver Verifications

If your waiver is approved, it is still subject to periodic verification throughout the academic year to ensure the plan you submitted is still active and still meets the University’s health insurance coverage requirements. It is incumbent on the student to ensure their plan remains active and in compliance with the University’s health insurance requirements throughout the current academic year, including summer and holidays. If your plan is found to be inactive or out of compliance, the University reserves the right to enroll a student in the student health insurance plan from the start of the period of non-compliance (even if your termination date was in the past) through the end of the current academic year. If your plan is found out of compliance, you will receive an e-mail notification from HSAC and you will have 14 calendar days to respond. If you have not responded within 14 calendar days, the University will proceed with enrollment in the student health insurance plan, assess your student account the applicable premium charges, and notify your program of your non-compliance with the University’s health insurance requirements.

Requests to waive out of the student health insurance plan must be submitted online via HSAC’s waiver portal by the deadlines posted below.

To ensure that health insurance coverage requirements are met, all full-time students are automatically assessed for half of the annual student health insurance premium upon registration for fall. This fee is reversed only if you submit proof of health insurance coverage that meets the University’s coverage requirements. When you fail to submit proof of alternative health insurance coverage by the deadline for your program/class year, your enrollment in the student health insurance plan is finalized. In addition, you are no longer eligible for a refund of the first half of the premium and you will automatically be assessed the second half of the premium upon registration for the spring term.

Waiver Appeals

If your waiver is denied, you may appeal the decision. The University will only override the waiver denial if you meet one or more of the following criteria: 1) as the student you are enrolled on a parent, guardian or spouse’s health insurance plan and the responsible party signs the High Deductible Appeal Form on your behalf; or 2) you can provide documentation (current statement) of a health savings account that holds a balance that will cover the difference between your health insurance plan deductible and the University’s $1,000.00 deductible requirement. Instructions and deadlines for submitting your waiver appeal will be provided in your waiver denial e-mail.

Waiver Deadlines

Program/Class Year Waiver Submission Deadline
MSMS 2020, ISAC 2023 (DO, DONW, DPM), DPM Advanced Standing) June 30, 2019
IPBP 2022 July 31, 2019
All Other Programs/Class Years August 31, 2019
MSBS, MSHS, MSPS Spring Semester Starts January 31, 2020
DMD-IDP 2022 March 30, 2020

 

If you originally waived out of the student health insurance plan but find that you need health insurance coverage later in the year due to an involuntary loss of coverage or if you have aged out of your parents’ insurance plan, you can also enroll via the Health Sciences Assurance Consulting website.

Students enrolling after the initial enrollment period due to an involuntary loss of coverage will be assessed a prorated portion of the insurance premium based on their dates of enrollment.

Students have 30 calendar days after an involuntary loss of coverage to enroll in the student health insurance plan or submit updated proof of coverage. Students must maintain continuous enrollment in health insurance. If you are submitting new proof of coverage, it must begin within 24 hours of the termination of your previous coverage. You are not eligible to waive if you have any gap in coverage.

If I remain enrolled in the student health insurance plan, can I opt out of the plan at the start of the spring term?

No, the student health insurance plan is sold as an academic year plan. Even though we charge half of the premium in fall and the other half in spring, you cannot waive out of the student health insurance plan after the first 30 days of the plan’s enrollment period has passed.

What happens to my student health insurance coverage if I am no longer enrolled (i.e. withdrawal, LOA, suspension or dismissal)?

Except in the case of medical withdrawal due to Sickness or Injury, any student withdrawing from school during the first 31 days of the period for which coverage is purchased will not be covered under the student health insurance policy, and a full refund of Premium will be made, minus the cost of any claim paid by Aetna. Students withdrawing after such 31 days will remain covered under the student health insurance policy for the term purchased, and no refund will be allowed.

I am 25 and on a parent’s health insurance plan. I will turn 26 in January. Can I still waive out of the plan for part of the year?

Students who are currently covered under the health plan of a parent, but who will age-out of their coverage after the waiver deadline period, may use their current coverage to waive out of the student health insurance plan. Approximately 30-45 days prior to the student’s 26th birthday, our insurance verifier, HSAC, will reach out to students in this situation to determine if they wish to enroll in the student health insurance plan (at a prorated rate) or submit proof of coverage from another health insurance provider. If a student wishes to waive with coverage from another carrier, the coverage must meet the University’s minimum coverage requirements and must be submitted to HSAC for verification within 30 days of termination of existing coverage. New coverage must be effective within 24 hours of your previous health insurance coverage.

I waived out of the student health insurance plan at the start of the academic year, but now I am aging out of my parent’s insurance plan. Can I enroll in the student health insurance plan later in the year? Will the premium be prorated based on my coverage dates?

If you waived out of the student health insurance plan but lost your health insurance coverage due to an involuntary loss of coverage (i.e. aging out of your parent’s plan, loss of employment, divorce, etc.), you may enroll in the student health insurance plan. If you would like to enroll, please contact Health Sciences Assurance Consulting (HSAC) directly at westernu@hsac.com. In your e-mail, include your student ID number, reason for loss of coverage, and dates of coverage required. HSAC will respond with the prorated cost of coverage based on your coverage dates.

I am enrolled in the student health insurance plan for the 2019/2020 academic year. How do I obtain my insurance card?

You can obtain your Aetna insurance card via the Aetna Student Health website (ASH). Aetna also offers a mobile application at www.aetna.com/mobile, which allows you to find a doctor, check benefits and coverage information, pull up your medical ID card information, or locate an Urgent Care center.

Can I use a WesternU Health center for health care services?

The providers within the WesternU Health centers are all members of the Aetna Student Health Plan. A referral or prior authorization is NOT required to see any primary care doctor or specialist in any of the services at a WesternU Health center. As Aetna Preferred Care Providers, you will generally have less out of pocket expenses for your care. Remember, however, that not all services will be considered eligible expenses and be reimbursed by your insurance plan.

If I am a Pomona campus student, am I required to visit WesternU Health | Pomona first before accessing health care services?

In previous years, the student health insurance plan required students who lived within a 25-mile radius of the University to seek care or obtain a referral from a WesternU Health center prior to visiting a physician. This is no longer a requirement under the Aetna Student Health Plan; however, you are encouraged to seek care from an Aetna preferred provider to help minimize your out-of-pocket expenses. Preferred provider visits are covered at 80% while out of network providers are only covered at 60%.

Additional Questions?

For additional information regarding the student health insurance plan or waiver requirements, please contact Health Sciences Assurance Consulting (HSAC) at westernu@hsac.com or 1-888-978-8355.