Sec. 1 Purpose
This policy applies to students who are not subject to UTS 186 and who are enrolled in medical and dental units, as defined by this policy. The purpose of this policy is to delegate authority to the institution president to define the category of students who are required to have health insurance based on academic program and/or the nature of the students’ clinical placement/experience.
Texas Education Code 51.952 authorizes governing boards to require a student enrolled at a “medical and dental unit” to have health insurance and requires the governing board to determine the minimum standards of coverage. Regents Rule 50402 delegates to the Chancellor the authority to approve a policy that defines the categories of students who are required to comply with this requirement.
The statutory definition of “medical and dental unit” is broader than simply medical and dental schools. The statutory authority to require students have health insurance was approved in recognition that students in academic programs with direct patient contact are exposed to greater health risks than other student populations. As such, for the purpose of this policy, the statutory definition of “medical and dental unit” applies to all programs offered at UT health-related institutions and at general academic institutions, any degree or certificate program that require a clinical placement/experience with direct patient contact.
Sec. 2 Authority of the President
2.1 For purposes of complying with Education Code 51.952 and Regents’ Rule 50402, the Chancellor delegates to each institution president, conditioned upon review and approval of the Executive Vice Chancellor, the authority to develop a policy to determine which students are required to have health insurance. Any such policy shall establish which portion of the academic program the student is required to have health insurance.
2.2. Consistent with Texas Education Code 51.952, the institution policy shall allow a student to be provisionally enrolled for one academic session without required coverage to allow the student time to obtain the coverage.
Sec. 3 Health Care Coverage Requirements for Students
3.1 Health Care Coverage is coverage provided through a Patient Protection and the Affordable Care Act (PPACA) compliant individual or employer health plan that meets the minimum federal requirements.
a) Such a plan must provide coverage that, at a minimum:
i. Provides the Essential Minimum Benefits required by the PPACA with no annual limits;
ii. Contains no exclusions for pre-existing conditions;
iii. Covers 100% of Preventive Care as defined by the PPACA;
iv. Imposes a deductible that does not exceed $500 per accident or illness;
v. Imposes no provisions for co-insurance that exceed 25% of the covered benefits per accident or illness; and
vi. 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.
3.2 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.
Sec. 4 Enrollment in UT SHIP Plan as Default Requirement
4.1 Each institution shall adopt a process, which shall include a mechanism for automatic enrollment, designed to ensure that during each academic session in which a student is required to have health insurance, the student is also enrolled as a participant in the Health Care Coverage offered through the UT SHIP Plan unless the institution has granted the student a waiver, pursuant to Section 5 of this Policy, that covers the requirement period.
4.2 Each student shall be assessed a Student Premium Fee sufficient to cover the cost of the UT SHIP coverage in which the student is enrolled under this Section 4.
Sec. 5 Waivers
5.1 Each institution shall adopt policies and processes for accepting applications from, and granting waivers, to students as permitted by the policy.
a) The policies and procedures must provide clear advanced notice to students and prospective students about the requirements of this policy reasonably calculated to assist these individuals in purchasing coverage that complies with the requirements of this policy, including an explanation that the most effective way to obtain such coverage is to enroll in the UT SHIP.
b) An institution may adopt policies and procedure for automatically determining if students qualify for a waiver under Subsection 5.1.
c) An institution may elect to enter into an agreement with the carrier that issues the UT SHIP to review waiver requests submitted by students to determine if the student qualifies for a waiver under Subsection 5.1
5.2 Grounds for Waivers. At a minimum, an institution shall grant a waiver to a student for any semester or academic session of enrollment in which the student has established that the student is:
a) Eligible for, and enrolled as, a participant in the U. T. System Employee Group Health Plan coverage;
b) Sponsored by the US Government or another sponsoring entity that has guaranteed payment of all health expenses and repatriation and evacuation expenses in writing; or
c) Able to establish that he or she is enrolled in Health Care Coverage through another source that meets the requirements of Section 3.1(a).
Sec. 6 Mid-Year Loss of Coverage; Enforcement Requirements
6.1 An institution must require a student to promptly report any loss of Health Care Coverage required by this policy that occurs during the student’s required enrollment period of coverage to the institutional office charged with compliance with this policy.
6.2 Institutions must provide that failure of a student to maintain coverage as required by the Policy is a violation of the institution’s student code of conduct and grounds for disciplinary action.
Definitions
Essential Minimum Benefits: A comprehensive package of benefits and services that must be included in a PPACA compliant health care plan 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 including 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 including:
- Evidenced-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force (USPSTF) with respect to the individual involved;
- Immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved;
- If the participant is an infant, child, or adolescent, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA); and
- If the participant is a women, evidence-informed preventive care and screening provided for in comprehensive guidelines supported by HRSA, to the extent not already included in certain recommendations of the USPSTF.
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. Such plans include policies for foreign students studying for only one or two semesters in the U.S.
