Personal Health Insurance

Personal Health Insurance Guidelines

All personal health insurance plans must adhere to the Affordable Care Act’s regulations. Proof of comparable coverage or the minimum coverage guidelines for domestic and international students that can be used to be eligible to “opt out” of the Student Health Insurance Program (SHIP) are as follows:

• Your plan does not have any limitations or exclusions on pre-existing conditions.
• Your plan covers hospital stays for medical/surgical care and (inpatient) mental health conditions.
• Your plan covers doctors’ office visits for medical and (outpatient) mental health conditions.
• Your plan covers prescriptions written by a doctor. (Prescription benefits through a third-party vendor — CVS Caremark, etc. — are acceptable.)
• Access to provider network within the Moscow/Pullman area. Coverage MUST be available for routine, diagnostic, urgent and hospital care. (Coverage for ONLY telehealth, urgent and emergency is NOT acceptable)
• Your plan covers services related to injury from participation in all types of recreational sports, including intercollegiate athletics.
• If your plan has a deductible, EITHER:
  • It must be equal to less than $1,500; OR you can confirm you have financial means to meet the higher deductible amount. (FSA/HSA account)
• Your plan covers maternity care, including prenatal care and delivery with no pre-existing condition limitations.
• Your plan provides coverage for diagnostic services, including laboratory tests.
• Your plan pays at 70% or more of usual, customary, reasonable charge per accident or illness, after deductible is met, for in-network, and 50% or more of usual, customary, reasonable charge for out-of-network providers per accident or illness.

Note: Travel Plans, County Medical Service Plans (Medicaid) outside the state of Idaho or Washington, Fixed Indemnity Plans, Short-Term Plans and Supplemental or Reimbursement Plans are not accepted as comparable coverage.

Compliance Standards:

To maintain compliance standards for the use of personal health insurance, all plans must be:

• Effective on or before the first day of the semester with no break in coverage.
• Effective on the first day of the calendar month following the first day of the semester.
• Effective on or before the first day of the calendar month following an involuntary loss of previous coverage.

To maintain compliance standards for the use of personal health insurance, all plans must NOT:

• Have gaps in coverage of no more than seven (7) days.
  • If longer than seven (7) days, must be able to provide proof of COBRA coverage.

Uninsured/Inadequate Insurance Policy

Students who are discovered to be uninsured or have insurance that does not meet the minimum requirements will be enrolled in U of I's Student Health Insurance Program and a semester charge will be placed on the student's account. The Student Accounts Office coordinates charges and billing for student accounts subject to University of Idaho financial terms and conditions. Additional information can be found at Student Accounts.