Clark University
STUDENT HEALTH INSURANCE PLAN

2014-2015 Academic Year

Dear Student:

The Commonwealth of Massachusetts mandates that all full-time and three-quarter-time students attending an institution of higher education in this state must be enrolled in a qualifying Student Health Plan that meets established minimum benefit guidelines.

All matriculated full-time and three-quarter-time students at Clark are required to carry health insurance and are automatically enrolled in and charged for the Clark University Student Health Insurance Plan. Only matriculated full-time and three-quarter-time students are eligible to purchase this plan.

ALL NEWLY ELIGIBLE SPRING 2015 STUDENTS MUST COMPLETE EITHER A WAIVER FORM OR ENROLLMENT FORM
BY THE DEADLINE OF DECEMBER 12, 2014, FOR THE 2014-2015 POLICY YEAR.

WAIVER FORM: Complete this form if you have other, comparable coverage and want to remove the $1,145 insurance charge from your student bill.

ENROLLMENT FORM: Complete this form if you want to expedite the processing of your Student Health Insurance enrollment. If you do not complete this form, your information will not be added to the insurance plan system until after the effective date of 1/1/15.

To complete either form, first click on the appropriate blue box on the left ("Undergraduate" or "Graduate"); then select "Waive" or "Enroll"; fill in all required information; and submit the form by clicking "Apply". You have not successfully submitted your form until you reach the confirmation page, which will provide you with a confirmation number. Print your confirmation page.


OTHER IMPORTANT NOTICES

ACCESS TO CARE IN THE WORCESTER AREA: If you are covered by a health insurance plan outside of the Worcester area, your coverage may be limited or not available while at Clark. This is particularly a concern if you are insured through a Health Maintenance Organization (HMO). Please check with your insurance company on possible limitations before submitting a waiver form. Health insurance plans that do not reasonably provide access for all health services to the student in the Worcester, MA area are not eligible for a waiver.

INTERNATIONAL STUDENTS: International students may not waive participation in the student health insurance program online. More information regarding requirements for international students can be downloaded from the Clark University website.

RETURNING STUDENTS: All returning Fall 2014 students needed to submit a new waiver or enrollment form for the 2014-2015 policy year by the final Annual 2014-2015 Waiver Form extended deadline of September 9, 2014, even if their decision or information has not changed since last year. If you are covered by the Student Health Insurance Plan through August 14, 2014, and do not complete a new enrollment form by the deadline, your insurance will become temporarily inactive until your name is resubmitted and reprocessed. (Please refer to the “Missing the Waiver/Enrollment Deadline” section.) A form MUST be on file for EVERY policy year during which you are a full-time or three-quarter-time matriculated student.

MISSING THE WAIVER/ENROLLMENT DEADLINE: Fall 2014 students who do not complete a health insurance waiver/enrollment form by the extended deadline of September 9, 2014 (or New Spring 2015 students by the December 12, 2014, deadline), will be automatically enrolled in and charged for the Clark University Student Health Insurance Plan in order for the University to be in compliance with Massachusetts Law. However, your enrollment information will not be sent to University Health Plans or Blue Cross Blue Shield until after the effective date. Therefore, in order for your plan to be active on August 15, 2014 (January 1, 2015, for New Spring students), you must submit your enrollment form by the original deadline of July 25, 2014 (December 12, 2014). Also, students looking to waive will not be eligible for a refund for Student Insurance after the extended deadline of September 9, 2014 (December 12, 2014, for New Spring 2015 students).

GENERAL PLAN INFORMATION: The Clark University Student Health Insurance Plan for the 2014-2015 year was negotiated with University Health Plans, Inc. and Blue Cross Blue Shield of MA. The plan covers students from August 15, 2014, through August 14, 2015, for the Annual Plan and from January 1, 2015, through August 14, 2015, for the Spring Plan. The cost to an individual student is $1,829 for the Annual plan and $1,145 for new students starting in the Spring.

The benefits for this plan can be found by selecting "Brochure" from the menu at the left of this page. The Student Health Insurance Plan covers individual students only and does not provide coverage for their dependents or other family members. To find Blue Cross Blue Shield providers click on the "Find a Provider" link. Should you have any enrollment/eligibility questions, please contact University Health Plans at 800-437-6448 or info@univhealthplans.com. For questions about benefits and claims, please contact Blue Cross Blue Shield of MA at 888-753-6615.

Sincerely,
Cathy White
Assistant Director of Student Account Operations