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Eligible Students Waiving the 2011-2012 Premier Plan During Their Open Enrollment Period

Letter to Students Waiving the 2011-2012 Premier Plan

Dear Student:

You may waive the Premier Plan offered by the University during the Open Enrollment Period, if you have other adequate health insurance which meets the following criteria:

• Coverage of at least $100,000 per illness and $100,000 per injury;
• Plan in effect no later than the last day or your applicable Open Enrollment Period; and,
• Plan will remain in effect for the remainder of your academic year.

Important considerations for waiving the plan are listed on in the Premier Plan Description of Benefits brochure under "Checklist for Health Insurance Coverage." Please carefully consider if your other health care coverage is adequate coverage in the D.C. metropolitan area before waiving the Premier Plan.

The Premium Rate including administrative fees, Terms of Coverage dates, and applicable Open Enrollment Period dates are below. Eligible students are mandated and charged the student rate for the applicable Term of Coverage, as indicated below. Students who submit an approved waiver during the applicable Open Enrollment Period will have the entire student rate refunded on their Student Account.

Fall 2011-2012 Plan Year:

Term of Coverage: 8/15/2011 – 8/14/2012
Open Enrollment Period: 2nd week in July - September 15, 2011

• $1,895 per student
• $5,516 per student and spouse
• $5,516 per student and child(ren)
• $8,680 per student and family

Spring 2011-2012 Plan Year:

Term of Coverage: 1/1/2012 – 8/14/2012
Open Enrollment Period: 2nd week in December 2011 – January 31, 2012

• $1,209 per student
• $3,454 per student and spouse
• $3,454per student and child(ren)
• $5,417 per student and family

Documentation of Other Coverage for the Entirety of Your Academic Year

Your other coverage must remain in effect through the earlier of:

• The end of the Academic Year; or
• Your graduation date.

In addition to submitting an online waiver, additional proof of coverage may be requested, such as a Certificate of Coverage written in English, which:

• Indicates that the coverage will remain in effect for the entire academic year, beginning no later than September 15, 2011;
• Indicates coverage for inpatient and outpatient treatment;
• Separately itemizes coverage of at least $100,000 per illness and $100,000 per injury;
• Clearly differentiates the required medical coverage from optional accidental death and dismemberment coverage;
• Indicates coverage for non-emergent care in the D.C. area;
• Indicates worldwide coverage or coverage in the United States; and
• Specifically states coverage amounts in U.S. dollars.

Waiving Online Through "MyAccess"

To promptly receive a credit on your student account, you may waive the plan online through September 15, 2011, by clicking through the following online web sequences:

• MyAccess,
• Personal Information,
• Answer a Survey, then
• Student Health Insurance Waiver Survey, Spring 2012.

Waivers are subject to approval by the GU Student Health Insurance Office.

To improve the accuracy of information, the Student Health Insurance Office has moved to a paperless process for the Acceptance and Waiver Forms, as have many other Departments. Students must accept or waive online through MyAccess. Keep a copy of your Acceptance or Waiver for your records.

Late Waivers

A $100 fee will be placed on your student account for late waivers received after your applicable Open Enrollment Period. The effective date of your other coverage must be prior to the last day of your applicable Open Enrollment Period, and remain in effect for the remainder of the academic year.

Best wishes for your success in the new year.

Sincerely,

Laura Hardman Crosby
Director, GU Student Health Insurance

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