Student Injury and Sickness Insurance Plan Highlights

Student Injury and Sickness Insurance Plan 2020-2021 All students are required to have health insurance and must obtain and maintain health insurance coverage while enrolled at the UNT Health Science Center. Degree-seeking domestic students enrolled in the Graduate School of Biomedical Sciences and the School of Public Health are eligible to obtain school-sponsored coverage on a voluntary basis. You may enroll in our coverage directly with our third-party vendor AHP. Our coverage is with United Healthcare. Enrollment and payment will be the sole responsibility of you student.

Rates Rates by Career This plan is underwritten by United Healthcare Insurance Company and is based on Policy #2020-203098-1 Domestic and #2020-203098-4 International. For a full description of coverage, including costs, benefits, exclusions, any reductions or limitations and terms under which the policy may be continued in force, log on to unthsc.myahpcare.com. Only GSBS/SPH Rates: Spring / Summer Annual Fall Spring Summer Monthly 8/10/2020 through 8/9/2021 8/10/2020 through 12/31/2020 1/1/2021 through 5/31/2021 1/1/2021 through 8/9/2021 6/1/2021 through 8/9/2021 $ 3,021.00 $ 3,021.00 $ 3,021.00 $ 1,192.00 $ 1,192.00 $ 1,192.00 $ 1,249.00 $ 1,249.00 $ 1,249.00 $ 1,829.00 $ 1,829.00 $ 1,829.00 $ 580.00 $ 580.00 $ 580.00 $ 252.00 $ 252.00 $ 252.00

Plan/Benefit Highlights Deductible $500 Deductible Per Insured Person, Per Policy Year for Preferred Providers; $1000 Deductible Per Insured Person, Per Policy Year for Out-of-Network Providers. What s a deductible? A deductible is the amount of money you must pay towards covered medical expenses before the insurance company pays.

Plan/Benefit Highlights Covered Medical Expenses for Preferred Providers are payable at 80% of Preferred Allowance and Out-of-Network benefits are payable at 50% 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).

Student Health Clinic Benefits Your co-pay will be waived and benefits will be paid for 100% of Covered Medical Expenses deductible incurred at the Student Health Clinic. Students paying the medical service fee are allowed access to providers for medical treatment. The following are covered at the Student Health and Wellness Center: 1) under the Health Center's annual Pap coverage except as mandated: Chlamydia (STD), Thin Prep, Gonorrhea, RPR (Syphilis), H/H CBC, HIV testing, urinalysis with reflex to urine culture, and CMP or BMP (blood chemistry) 2) an annual physical for men and women will cover the examination and lab work, including BMP or CMP, urinalysis with reflux to urine culture, STD testing and CBC; 3) acne treatment (acne medications will be covered under the Prescription Drug benefits); 4) All CDC recommended immunizations, including HPV and Bacterial Meningitis are covered (If not a PPACA mandated benefit, a $25 Copay is applicable); 5) Immune Titers; 6) Screening for Tb. If the test result is positive, a 1-view chest x-ray to determine if contagious. 7) TSH with reflux to T4 Needle stick/Face splash as a result of course work in a clinical setting will be paid as any other injury or sickness.

Turning 26 this year? Turning of Age 1. Process the waiver (Unless you wish to have double insurance coverage) 2. Contact health@unthsc.edu two weeks prior to losing your current coverage 3. Complete the Qualify Life Event application and return to health@unthsc.edu 4. Charge will be placed on your tuition bill and coverage added for the requested dates.

Dependents Spouse and Dependent Children may be insured for the same coverage period as the student. Enrollment in and payment for dependent coverage is the sole responsibility of the student. Coverage can be added at any time. Visit UNT Health Science Student Health Insurance for pricing and enrollment information.

United Healthcare Global: Global Emergency Services Domestic students are covered when they are 100 miles or more away from their campus or home address. International students are covered worldwide except in their home country.

Deadline Students taking no action (waiver or activation) will be automatically enrolled in the health plan after the census date. Pharmacy September 1, 2020 DO-PT August 4, 2020 PA August 25, 2020 International - GSBS- SPH September 1, 2020 *Census dates for each program may be found on the Registrar s website under Academic Calendars.

Optional Dental and Vision Coverage You are not required to be enrolled in the health plan to enroll in dental and/or vision coverage. Visit websites Cigna Dental Coverage: https://cignaindividual.com/public/Quoting/Individual/ VSP Vision Coverage: https://www.individualbrokervision.com/Enroll/ to obtain pricing and enrollment information.

Immunization Requirement Meningitis Students who are 22 years old and younger*, will be required to provide documentation of a bacterial meningitis vaccination (or submit a waiver/exemption) by the deadline. The bacterial meningitis vaccination or booster must be administered within five years of the deadline. Records must be received by 5:00 PM 10 days before the first day of class. We will be evaluating compliance after the census date each semester. If you have not met requirements between that time and before registration for the next semester, you will have a hold placed on your account. The hold will only block initial registration for the subsequent semester. We will begin enforcing compliance using the Medicat system during the Fall 2020 semester.

Contact Us Student Health Insurance Office of the Registrar Mayra Garcia Phone: 817-735-2341 Email: health@unthsc.edu Immunization Requirements Student Health Clinic Catrenia Thomas Phone: 817-735-5051 Email: studenthealth@unthsc.edu Student Health Insurance Website: https://www.unthsc.edu/students/student-health-insurance/