Health Care Coverage Requirements for Students
- Health Care Coverage must be provided through a Patient Protection and the Affordable Care Act (PPACA) compliant individual or employer health plan that meets the minimum federal requirements for coverage set forth in 22 CFR 62.14 (b) and (c) and (d). Such a plan must provide coverage that, at a minimum:
- Provides the Essential Minimum Benefits required by the PPACA with no annual limits;
- Contains no exclusions for pre-existing conditions;
- Covers 100% of Preventive Care as defined by the PPACA;
- Imposes a deductible that does not exceed $500 per accident or illness;
- Imposes no provisions for co-insurance that exceed 25% of the covered benefits per accident or illness; and
- Is underwritten by an insurance carrier that meets the requirement of 22 CFR 62.14(d)(1) or offered or underwritten by a federally qualified HMO or competitive Medical Plan as determined by the US Department of Health and Human Services.
- Plans that do not meet the Health Care Coverage requirements of this policy include:
- Short Term Limited Duration Plans; and
- Other health plans created expressly for the purpose of providing coverage to international students and/or non-immigrant visa holders.
- Individual plans provided through the federal Health Insurance Marketplace (or “Exchange”) or a state Health Insurance Marketplace (or “Exchange”) provide coverage that meets the Health Care Coverage requirements of this policy.
- A waiver shall be granted to a Student for any semester of enrollment in which the student is:
- Eligible for, and enrolled as, a participant in the UT System Employee Group Health Plan coverage;
- Sponsored by the US Government or another sponsoring entity.
- Able to establish that the student is enrolled in health care coverage through another source that meets the requirement of #1 above.
Essential Minimum Benefits: A comprehensive package of benefits and services that must be included in a PPACA compliant health care, including:
- Ambulatory patient services
- Emergency services
- Hospitalization (such as surgery)
- Pregnancy, maternity, and newborn care (care for a mother and baby before and after the baby is born)
- Mental health and substance use disorder services, including behavioral health treatment, counseling and psychotherapy
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
Preventative Care Medical care that must be offered to participants in health coverage with no out of pocket costs to the plan enrollee.
Short Term Limited Duration Plans Health insurance coverage provided pursuant to a contract with an issuer that has an expiration date specified in the contract (taking into account any extensions that may be elected by the policyholder without the issuer’s consent) that is less than 12 months after the original effective date of the contract.