Clemson University : Redfern Health Center : FAQ's about Student Health Insurance Plan

Why do I need health insurance?
The cost of health care has become prohibitively high. While Student Health Services provides economical primary care for students, it cannot meet all potential health care needs. Many students need treatment for an illness or injury that requires hospitalization, surgery, or specialty care. The resulting large medical bills can, and often do, interfere with meeting educational and career goals. We have seen students suffer significant illness or injury, and because of high cost and lack of adequate health insurance coverage, either deny themselves needed health care or discover that providers are reluctant to accept uninsured patients. To reduce health risk, avoid devastating medical charges, and ensure reliable access to health care services, all persons, including university students, need health insurance coverage.

Why is health insurance mandatory for full time graduate students?
Clemson University has always strongly recommended that all students have health insurance to ensure access to high quality and reliable health services and to offer a buffer against devastating medical costs for serious illnesses, injuries, or hospital visits. The importance of health insurance for graduate students was an important issue that was initiated by the Clemson Graduate Student Government (GSG). The GSG underscored the need for a health insurance package for graduate and teaching assistants, and, in addition, made it a top priority to secure a health insurance subsidy from the university to help defray the cost to the student. The GSG working with Dr. Bruce Raefert, Dean of the Graduate School, was able to accomplish this goal. The subsidy for the 2008-2009 academic year is $750 annually, $375 per semester. The Graduate School has made this subsidy available as part of the ongoing effort to recruit and retain the highest caliber graduate students for Clemson University. In order to secure an affordable health insurance plan that meets the needs of the student, Clemson University instituted a hard waiver insurance policy as a condition of enrollment.

Do I need to complete any enrollment forms to be enrolled in the Student Health Plan?
When the premium fee is charged to your student account, you are automatically enrolled in the Student Health Plan. However, we strongly encourage that you go to the student insurance web site at http://www.studentinsurance.com/ and create an online account so that you can print a temporary insurance card and have access to view your EOB’s online. If the fee for the Student Insurance Plan is added to your tuition, choose Mandatory when creating your online account. Once you have created your account online, you can go to the student insurance web site and choose My Account to change your address, print a temporary insurance card, request a new insurance card if yours is lost, or check EOB’s (Explanation of Benefits).

If I am a graduate student, is the insurance fee always added to my tuition fees?
Not always. The insurance fee is only added to your tuition & fees if you are a full time student taking nine (9) or more credit hours on campus; have a graduate or teaching assistantship; or you are an international student. If you have insurance for one semester and then your status changes the next semester, for example, you drop to 6 credit hours, the insurance fee is not going to be automatically added to your student account. Additionally, if you enroll for 9 hours initially and the student insurance fee is added to your account and then you drop a class, the insurance would not be mandatory for you anymore and the charge would be removed from your account.

It is important that you check your student account each semester and after any change in status to make sure the fee has been included if you want the insurance. If the insurance fee has not been added to your tuition & fees, or if the fee is removed due to a change in status, and you want the insurance, then you must enroll as a voluntary enrollee because the insurance is not mandatory for you for that semester.

What is Clemson’s “hard waiver requirement”?
All full-time graduate students (enrolled in nine or more credit hours on campus) and all international students are required to have health insurance coverage. If you are in this category the premium for the Student Health Insurance Plan will be included with tuition & fees for Fall 2008 and Spring 2009 (the fee for spring includes coverage for the summer). Students who pay the billed premium are automatically enrolled in the Student Health Insurance Plan unless a waiver is submitted and approved of comparable or better alternate health coverage. As stated above, eligible graduate students will receive a subsidy of $375 per semester to help defray the cost of the insurance premium for the student. The University will grant the subsidy only to those eligible students who purchase the Student Health Insurance Plan.
Students submitting waivers are required to have health insurance coverage for the full 2008-2009 academic year that meets the University’s requirements. Waivers may be submitted for the full academic year in the Fall or at the beginning of each semester.

What if I am already covered by health insurance and the fee for the Student Health Insurance Plan is added to my tuition fees?
If you are covered by a health insurance plan that meets the University’s requirements, then you are eligible for a waiver. See the following for acceptable alternate coverage that meets the university’s requirements for waiver and instructions on how to waive the Student Health Insurance Plan and have the charge removed from your tuition & fees.

What are the University’s requirements for alternate insurance coverage that would qualify for a waiver?
Alternate health insurance plans submitted for waiver must provide coverage and benefits comparable to or better than the Student Health Insurance Plan.
The plan must provide:

1. Inpatient and outpatient medical and mental health coverage including lab, x-ray, and other diagnostic testing
2. Inpatient and outpatient surgery benefits
3. Prescription drug coverage
4. Maternity benefit for female students covered as any other sickness
5. A minimum of $100,000 in coverage per illness or injury
6. Medical evacuation and repatriation, minimum $10,000 each (for international students only)

Insurance plans that restrict enrollment based on national origin such as those sold only to International Students will not be accepted for waiver.

It is strongly recommended that students purchase coverage on a continuous basis to avoid any breaks in coverage which re-start pre-existing condition exclusions.

How do I submit a waiver?
Go to http://www.studentinsurance.com/ , type in Clemson at Search, then choose the Waive option. Waivers can only be processed online. Fill in required information and submit. You will receive an e-mail from the insurance company informing you that the waiver has been received. It will take approximately three days for your insurance information to be verified. Once verification has been completed, you will receive a second e-mail informing you if your waiver has been accepted or denied. If your waiver is accepted, the student insurance company will send a waiver request to your Student Accounts and the student insurance charge will be removed. You will need the following information to complete the waiver:

1. name and address of your insurance company
2. policy holder's name and identification
3. policy number
4. insurance company's customer service telephone number (for verification of coverage)

Waivers may be submitted from July 14 through September 15, 2008. NO ONLINE WAIVERS WILL BE ACCEPTED AFTER THIS DATE. Please note that it may take up to 5 business days from the time you receive notification that your waiver has been approved for the charge to be removed from your student account. Please make sure that if you are requesting a waiver for the full academic year, you choose “Annual”. If you want to waive only Fall semester choose “Fall”. If you choose Fall and then determine you want to waive in the Spring, you must submit another waiver.
If you feel your waiver has been denied in error, please contact the Student Insurance Office at Redfern Health Center. You may call the Student Insurance Office at (864) 656-3561 or e-mail Vickie Metz, Student Insurance Office Manager, at svickie@clemson.edu.

How will I know when the insurance charge is removed from my account?
It can take approximately 5 business days from the time you get the e-mail notifying you that your waiver request has been received until the charge is actually removed from your student account. If the charge has not been removed after 5 days of receiving the notification that your waiver has been accepted, contact the Student Insurance Office.

It is the student’s responsibility to check the student account to make sure the fee for the Student Insurance Plan has been waived.

What is the difference between the health fee and the Student Insurance Plan?
University policy requires all students registered for seven (7) or more credit hours (three hours during each summer session) to pay the University health fee. The health fee supports all services at Redfern Health Center and includes:

* Professional services for primary health care providers, psychologists and counselors, and Health Educators.
* Reduced costs on pharmaceuticals, laboratory, and X-ray services
* $500 urgent care EXCESS benefit for after hours urgent or emergency medical care (insurance carrier determines covered benefit). Contact the Student Insurance Office the next business day after urgent or emergency care is received for more information.

My program is located off campus in another city. Will I still be able to use the Student Health Insurance Plan?
If your program is located off campus, you would still be able to use the insurance. Since you would not be using Redfern Health Center, you would look on the web site to find network providers in your area. Deductibles and co-pays would apply to visits. You would be able to use your insurance card as a pharmacy card for prescriptions, subject to co-pays. Referrals would not be required for treatment if you are more than 30 miles from Redfern Health Center.

What is the difference between Mandatory and Voluntary enrollment?
Graduate students enrolled in nine (9) or more credit hours on campus; all graduate and teaching assistants; and all international students automatically have the fee for the Student Health Insurance Plan added with tuition & fess. This is considered Mandatory enrollment because it is mandatory for students in these categories to have health insurance. The fee for the Student Health Insurance Plan is added to Fall and Spring tuition & fees. The Spring fee includes enrollment for the summer.
If a graduate student is enrolled in less than nine (9) credit hours on campus, takes online classes or classes at the University Center in Greenville, then the fee for insurance is not automatically added with tuition & fees. It is the student’s responsibility to check the online bill each semester to make sure if the insurance fee has been added. Any graduate student enrolled in at least one (1) credit hour is eligible to enroll in the Student Health Insurance Plan, however, the fee for the insurance will not and cannot be added with tuition & fees. If a student does not have the fee for insurance on the student account and wants to be enrolled, the student must enroll directly with the student insurance company online or come to the Student Insurance Office and fill out an enrollment form and write a check for the premium. This is Voluntary enrollment. Undergraduates are not required to have insurance by the university but are eligible to enroll in the Student Health Insurance Plan if enrolled in a minimum of six (6) credit hours. Undergraduates are Voluntary enrollees and must enroll online or at the Student Insurance Office. Voluntary Enrollment is only allowed during open enrollment periods unless the student has a “qualilfying event”. Qualifying events include aging off a parent’s plan, marriage, or involuntarily losing coverage under their current insurance plan. The student must enroll within 31 days of the qualifying event or will not be able to enroll until the next open enrollment period.

If the fee for the Student Health Insurance Plan is not added to my tuition & fees, but I want the insurance, how can I enroll?
Graduate students who are not in the category for mandatory insurance can enroll in the insurance as a Voluntary enrollee. A graduate student must be registered for at least one credit hour to be eligible to enroll. To enroll online go to http://www.studentinsurance.com/ , type in Clemson at Search, and choose Voluntary. You can pay the premium online directly to the insurance company. You will have the option to pay for the full year, by semester, or through a monthly bank draft.

Can I add my family to my Student Health Insurance Plan?
Any student insured by the Student Health Insurance Plan may add their legal spouse and/or any unmarried dependent children under the age of 19 to their health insurance policy during open enrollment. For each family member enrolled in the Plan an additional premium must be paid directly to the insurance company with enrollment information for the family member. The premium for a spouse or dependent cannot be added to the student’s tuition & fees. For international students, a spouse or dependent may be added to the insurance during open enrollment or within 31 days of arrival in the U.S. (passport required to show date of entry to the U.S.). Newborn children must be added to the insurance plan within 31 days of birth. Spouse and dependent enrollment may be done online or at the Student Insurance Office.

Where is the Student Insurance Office?
The Student Insurance Office is located in Room 105 in Redfern Health Center.

What is Open Enrollment and what are the dates for Open Enrollment?
Open enrollment is the first 31 days of the fall or spring semester during which any student that meets the qualifications for voluntary enrollment may enroll themselves and family in the Student Health Insurance Plan. This is the only time when a spouse and/or dependent children may be added to the plan. The student may enroll online or at the Student Insurance Office. Open enrollment for Fall semester ends on September 15th and open enrollment for Spring semester ends February 5th.

Is there any way for a student or student’s family member(s) to enroll in the Student Health Insurance Plan outside of Open Enrollment?
The following “qualifying events” are the only exceptions that will permit a student to enroll themselves or family outside of open enrollment:

1.) Adding a new dependent (within 31 days of marriage, birth, or adoption)
2.) Enrolling as a new or transfer student (within 31 days of date of enrollment)
3.) Becoming ineligible for coverage from prior health insurance company due to age, marriage, or loss of employment (within 31 days of loss of coverage with appropriate documentation)

For international students, if family member(s) join you at Clemson, they can be enrolled in the Student Health Insurance Plan within the first 31 days of arrival in the U.S. A passport must be presented at the Student Insurance Office to show the date of arrival.
Enrollment of student and/or family members requires payment of premium due for that enrollment period.

Are premiums pro-rated if enrollment is outside of the Open Enrollment period?
Any pro-rating of premium would be determined by the insurance company based on the date of enrollment.

When will I get my insurance card?
Once you have paid Clemson University for the insurance go to the Student Insurance website at http://www.studentinsurance.com/, choose Clemson and then choose Mandatory Plan and New Student. Check the box that states you have paid the insurance to the university, click Mandatory again and then create your account. Once this has been completed you will be able to print a temporary insurance card. Clemson University does not get the list sent to the insurance company until about 6 weeks into the semester. Once the list has been sent to Pearce Administration your permanent id card will be mailed to you. Please make sure your address in SIS is correct as this is the address where the card will be mailed.
Voluntary enrollees will receive their insurance card within a couple of weeks of enrollment.

I get statements from the insurance company, are these bills?
These are not bills, these are EOB’s (Explanation of Benefits). Each time a claim is submitted for medical services, either from Redfern or any other medical provider, the student insurance company will process the claim to determine payable benefits according to the specifications of the Student Health Insurance Plan. They will determine any discounts given for network providers, how much of the charge went to deductible, any co-pay amount, and patient responsibility. Patient responsibility is the amount the student must pay the provider. The insurance company then sends a statement to the student to show how the claim was processed. See the link on the student insurance web site on “How to Read an EOB”. Sometimes this EOB will show that no payment was made due to additional information needed from the student or medical provider. It is the student’s responsibility to respond to requests for additional information requested on the EOB. The claim cannot be processed until this information is received. One example of additional information requested by the insurance company could be the submission of an accident/injury questionnaire which can be obtained online at the student insurance web site, from the Student Insurance Office, and is also mailed to you from the insurance company with the EOB. These accident/injury questionnaires must be completed for any accident or injury that required medical treatment to determine if another party is liable for the medical expenses. Another common request is for a HIPAA certificate. If you have been on the insurance for less than one year and a claim is submitted for an illness or injury that could be or is a pre-existing condition, the insurance company needs a “certificate of coverage” or “HIPAA certificate” from your prior insurance company to show when coverage with that company began and ended. The insurance company also needs to know if you are covered by another insurance plan in addition to the Student Health Insurance Plan. Whenever you terminate from an insurance company, they should automatically send this certificate to you (or the covered person) or you can call and request it from them. Medications for pre-existing conditions are covered, but other services such as lab tests, X-rays, or referrals to outside providers may not be covered if you do not meet the criteria for having pre-existing conditions covered. Pre-existing conditions are not covered for the first 12 months that the student is insured unless the student meets all four criteria for having the pre-existing condition exclusion waived.

What is a pre-existing condition?
A pre-existing condition is any sickness, injury or any other medical or mental health condition existing in the six month period prior to the Covered Person’s effective date of the Student Health Insurance Plan. If symptoms were present during the six month period that have been treated or evaluated by a physician, have been recommended for treatment by a physician, or symptoms of an illness or injury existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment, the condition is considered to be pre-existing.

Are pre-existing conditions covered under the Student Health Insurance Plan?
Pre-existing conditions are not covered during the first twelve (12) months of enrollment in the Plan. Exceptions apply if the Eligible Individual meets all four (4) of the following criteria:

1.) The individual had 18 months of continuous creditable coverage under a previous health insurance plan;
2.) applies for the student health insurance plan within 63 days of termination of the creditable coverage under the prior health insurance plan;
3.) whose most recent health insurance coverage was under an employer group health plan, and
4.) the student, dependent, or spouse must accept and use up all COBRA or continuation of coverage if it is offered.
If a student, spouse and/or dependent fails to meet any of these qualifications the pre-existing condition will not be covered by the student health insurance plan for the first twelve months of coverage (medications for the pre-existing condition are covered).

Prior individual health plans are not considered creditable coverage in South Carolina

Will the Student Health Insurance Plan cover me if I go to any doctor?
Students and spouses covered by the Student Health Insurance Plan must use Redfern Health Center as their primary care facility. To use the insurance outside of Redfern it must be

1) A referral by a Redfern provider to another doctor or facility
2) Medical emergency
3) Student or spouse is more than 30 miles from Redfern and requires immediate medical attention

Deductibles and co-pays apply for any visits outside of Redfern Health Center. If a student requires emergency medical treatment and has paid the health fee, there is a $500 EXCESS benefit (called A&I coverage) that can be accessed to help cover the costs of the emergency visit only. In the event that emergency medical care is received outside of Redfern Health Center, please contact the Student Insurance Office the next business day for information on accessing this benefit. The insurance company determines covered benefit.
If you have an emergency visit and are referred to another provider by the emergency room or urgent care physician, please contact the Student Insurance Office for a referral or to see if follow up care can be done at Redfern Health Center.

Am I still covered by the Student Health Insurance Plan if I am not enrolled for any classes during the summer?
When a student enrolls in the Student Health Insurance Plan for the spring semester and pays the health insurance premium, this premium includes coverage for the summer. If a student is not enrolled in any summer classes the student health insurance coverage remains in effect through the summer without any changes in benefits. Students not enrolled in classes during the summer are not paying a health fee, therefore, a $15 co-pay will apply to office visits at Redfern. All other benefits remain the same.

Why is the Spring premium higher than the Fall premium?
The fall premium covers the fall semester only, Aug 15th – Jan 5th , a coverage period of 5 months. The spring premium includes the premium for summer so the student does not have any lapse in coverage and covers from Jan 6th – Aug 14th, a period of 7 months, to ensure the student has year round coverage.

If I am not enrolled for any classes during the summer, why do I still have to pay for insurance?
Students should be covered by insurance year round. Students can suffer an illness or injury in the summer the same as they could in the fall or spring and would need insurance coverage to cover the costs. Any lapse in coverage also causes the pre-existing waiting period to start over.

How can I find a list of doctors and hospitals who are in network providers?
Go to the web site at http://www.studentinsurance.com/ to search the provider network.

Does the Student Health Insurance Plan cover dental?
The student is reimbursed 100% for the following dental services:

1. Two Annual Comprehensive Oral Evaluation
2. Two Annual Adult/Child Cleaning
3. One Annual bitewing X-rays (up to 4)

The student may go to any dentist, pay up front, bring the receipt to the Student Insurance Office or mail to the Student Health Insurance Company. A reimbursement check will be mailed to the student (make sure your address in your Student Insurance Company account is correct).
Reimbursement takes 4-6 weeks.

Other dental services are not covered.

Does the Student Health Insurance Plan cover vision?
There is no benefit for vision coverage under the Student Health Insurance Plan, however, the student can access the Wellness Benefit to cover a vision screening. Injuries to or medical conditions of the eyes are covered (excluding pre-existing conditions for the first 12 months of coverage).

What is the Wellness Benefit?
The Wellness Benefit is a $300 benefit that the student may use for preventive or wellness services such as immunizations, vision exam, physical exam, screening laboratory services, etc.

Are there exclusions in the insurance plan?
There are exclusions in the insurance plan. Not every medical condition is covered by the insurance. Please review the exclusions in the insurance plan so that you will be aware of non-covered services or benefits.

Definitions of insurance terms
There are terms used in these FAQs that you may not understand or know the meaning of. For definitions of insurance terms such a deductible, co-pay, network provider, etc. go to the student insurance website and access their definition of insurance terms. If there are still issues regarding the Student Insurance Plan that you do not understand, please come by, call, or e-mail the Student Insurance Office.