OHSU Mandatory Student Health Insurance Plan. (Note: OIT students in the Clinical laboratory Science and Paramedics training programs and OSU 4th yr. Pharm.D. students are excluded from this requirement and may disregard this section.)

The Plan. OHSU has a policy of mandatory student health insurance and arranges for a single group major medical health insurance plan to be available for all students. OHSU is the policyholder and the current underwriter of this insurance plan is ODS. The Student Health Service administers this program throughout the year. It is the responsibility of each training program to direct prospective and accepted students to this website to learn about this program, including any applicable administrative deadlines. The OHSU fee book, which is published in the spring of each year for the next academic year, contains information about premiums (fees) as well as tuition for all students of all programs. The Student Health Service does not set these fees.

Each year a Student Health Service Advisory Committee, consisting of OHSU student and faculty representatives, works to study and make improvements in this insurance plan for the coming year. This group consults with an independent insurance consultant/broker who brings knowledge of the market, provides analysis of our “experience” including the claims costs, premium income, and administrative costs in light of benefit structure, and helps communicate with the current company underwriting this group insurance plan. Any changes to the plan are made in the spring term, and take effect at the beginning of the fall term each year.

This student group insurance plan is “integrated” with the primary care and counseling services provided by your Student Health Service. No Student Health Service can provide all of the comprehensive range of services of the health care system. However, using the principles of primary care health services management, acting as your “medical home” the Student Health Service is able to provide on-campus confidential primary and secondary prevention services for students, and the health insurance allows the students to access the broader range of services when necessary, with a cap on total out of pocket costs each year, as a feature of the insurance plan. Mental health services are provided at the Student Health Service in Portland as described elsewhere on this website. The mental health benefit of this insurance provides coverage for needed services outside the Student Health Service if they are not available in the counseling service at the Student Health Service. Access to these outside services is applied for by the insurance enrollee through ODS Behavioral Health (a subsidiary of ODS) who then determines necessity and eligibility. (Note: The Student Health Service providers do not make the decision about coverage or approval of outside mental health referrals. This is called being the “gatekeeper” and we do not do this.)

An important underlying principle of the OHSU student group health plan has always been that every OHSU student is guaranteed coverage by the plan. Spouses and dependents of students are also guaranteed coverage if they elect coverage (see below.) If a student elects to carry the insurance after graduation, it is available, at a higher premium, and may be extended for a minimum of 3 months up to a full year after graduation for students (and their covered dependents) graduating fall, 2007 or later, protecting the student from a lapse in coverage.

If a student arranges a school-approved leave of absence, the student (and the student’s dependents) may maintain this coverage for up to a year.

The premiums for this student group plan are automatically assessed to the student’s account by the registrar each term. The premiums are prorated to the number of months in each term. Thus the premium for a one month term or a four month term would be proportionately less or more than a “standard” three month term.

If a student is not enrolled for a term, the student must arrange with the Student Health Service to continue this insurance and pay the premium in order to avoid a break in coverage. If there is such a break in coverage, and the student returns, the student will be a “new” student on the group plan, requiring new enrollment in the plan (at the same time there is an influx of new students to OHSU) and there may be a delay in receiving the new insurance ID wallet card. During this time that the student is fully covered by insurance, but has not yet received the wallet card, he or she may have difficulty proving coverage, even with a phone call by the provider to the insurance company. In this case the student may temporarily need to pay cash or use a credit card for services, prescriptions, etc., and then fill out forms to be reimbursed by the insurance company for any covered services during this transition period. A call during business hours to the Student Health Service may allow us to assist you if this occurs. If you are contemplating a break in coverage during a period of non-enrollment, such as a vacation quarter, there may be other consequences as well. If you develop a condition during that period in which you are not covered, it may be considered a pre-existing condition when you return to coverage and you may need to wait before services needed for that condition can be reimbursed. Please carefully think through these options before you leave yourself uninsured or possibly underinsured for a period of non-enrolled status.

Exceptions. The waiver. Oregon law provides that an educational institution may approve a student’s request to decline coverage from the approved health insurance plan if the student provides evidence that the student has health coverage similar to the approved plan.

OHSU mandatory student group health insurance policy requires that the insurance be available to all students (and their dependents) with no exclusions except that they are currently enrolled students. There is a minimum lifetime benefit of $1,000,000.00. Thus, a request to decline coverage from the University student group health insurance plan (a waiver application) must show that the student’s current insurance plan for which a waiver is sought meets these two basic health coverage features of the university student plan, i.e. to be approved it must be a plan open to all members of a group regardless of individual circumstances, including past medical history, race, ethnicity, gender, etc. And it must insure adequately against unanticipated medical costs at a minimum of a million dollars lifetime benefit. Plans that have a million dollars of lifetime benefit, but restrict coverage per condition or illness to a lower level, do not satisfy this criterion. Evidence of the following would meet these criteria:

Employer group coverage with a minimum lifetime benefit of not less than $1,000,000.00, where the insured is a spouse or a parent of the student, or the student’s own employer group plan when the student is employed. (Employer group insurance is open to all in the group regardless of personal circumstances. Individual insurance plans do not qualify for this waiver. These plans require a medical screening process to exclude certain individuals. This violates the OHSU policy of inclusive coverage guaranteed to all enrolled students and their dependents.)

Coverage under Medicare, Medicaid, FHIAP, OMIP, or coverage under a Cobra plan that extends employer group coverage.

A unique individual plan providing a minimum of $1,000,000.00 lifetime benefit that meets extenuating circumstances such as the following: the student with a permanent ongoing medical condition who would not qualify for insurance for that condition after graduating and terminating the required OHSU student group insurance, is requesting a waiver to keep a plan which is guaranteed renewable permanently if not terminated, but would be irrevocably lost if terminated to enroll in the OHSU student plan.

These criteria are subject to change on an annual basis, and any changes will be announced to new and continuing students in the month of May each year.

Deadline for waiver application and expiration dates. Applications for new waivers must be received in the Student Health Service office before the first day of the month in which a student’s program starts. Postmarks are not sufficient. The waiver application must be signed. Regardless of the effective date of a waiver, all waivers expire at the end of summer term. To continue an approved waiver, it must be reapplied for annually before the first day of the month in which the student’s fall term begins. A student with a waiver that has expired at the beginning of fall term will automatically be enrolled in the student group health insurance plan and the premium for the entire term will be assessed to the student account. If a subsequent waiver application is submitted and is approved, it would take effect at the beginning of the month following approval, and the remaining premium for that term refunded. Waiver applications received at any other time, e.g., to join a spouse’s employer group plan, where the student is terminating the student group plan, must be approved prior to the first day of the month in which they take effect. Applications which are incomplete, and are received in this office but do not include the required documentation as indicated on the waiver application form can not be considered until they are complete with all the required documentation. If a student wishes to apply for a waiver at any other time, the student may do so. If approved, the waiver would become effective the first day of the month following approval. Until that time, the student would be automatically billed for and covered under the OHSU student group plan. Finally, any waiver applications based on the third criterion (extenuating circumstance of a medical condition) must be to keep insurance already in effect, not for a new policy; and it must be shown that the insurance is otherwise renewable with no conditions other than continued payment of premium. For example, if continuing the individual plan would not be guaranteed if the enrolled person would move away from the locality in which he or she is currently insured, this insurance would not qualify for the waiver.

Appeals of Waiver Denial Decisions. A student whose request to decline coverage (waiver application) under the university plan is not approved, may appeal in writing to the Director of the Student Health Service at OHSU. The Director, based on the above criteria, will make the final decision.

Coverage of family members To enroll your family members, read the Health Insurance section of this website regarding open enrollment time, deadline, and “qualifying events” for new family members. You may contact us at askshs@ohsu.edu for assistance in enrolling them. When they are enrolled, coverage will start when your’s does (the first day of the month in which your classes begin), and the premiums will be assigned to your student account and appear with your tuition bill and other fees each quarter.

Dental/Vision Coverage. Unlike the student group major medical plan, coverage under the student group dental and vision insurance plans is not mandatory by OHSU unless it is elected by each student group in the spring (by April 1) for it to become effective at the beginning of the Fall term (the first day of the month in which the group’s fall term begins). If a group elects in the spring to have dental and vision coverage, it will become effective (and mandatory) for that group for the next academic year, starting the first day of the month in which fall term begins.

There are eight student groups for purposes of this election process: Portland campus School of Nursing including nursing MPH; Regional campus School of Nursing in LaGrande; Regional campuses of the School of Nursing in Klamath Falls and Ashland; School of Medicine students including PA, Informatics, and non-nursing MPH; School of Medicine medical graduate; School of Dentistry; Allied health including radiation oncology; CDRC (not surveyed in spring 2007); OSU Pharm.D. 2nd year students (at OSU, coming to Portland campus for 3rd year). Both dental and vision insurance are elected or rejected together by each group.

Each training program, with the assistance of the faculty and student members of the Student Health Service Advisory Committee, will be responsible for surveying the students of these groups to determine a decision regarding election or non-election of this dental/vision coverage by April 1, during winter or early spring term. The information used by students in making their individual decision should be their own personal need for such coverage and the current year’s benefit structure and premiums as posted on the website (see the section ODS Benefit Info on this website) understanding that these could change and might not be exactly the same when finalized in May. The final results of election will be posted on the website by mid-May for the following academic and insurance year which starts at Fall term.

If elected by a group, the coverage will be mandatory for each member of the group, and the premiums will be automatically assessed to the students’ tuition accounts beginning on the first day of the month in which fall term starts (exactly like the student group major medical premium) and each term thereafter. The premium will be prorated by the number of months in each term.

J:/sharing/website pages/Mandatory OHSU SH Insurance 06212007.doc