Frequently Asked Questions
Do I have to have the UNC Student Health Insurance in order to use the Student Health Center?
No. The Student Health Center is available to any UNC student.
If I have the UNC Insurance plan do I have to see someone at the UNC Student Health Center first if I am ill?*
Yes, in many cases the student is required to go to the UNC Student Health Center before seeking health care elsewhere. If you are more than 20 miles away from the health center, you can see anyone in the Cigna network.
The covered person must use the resources of the University Health Services (Student Health Center) first where treatment will be administered or a referral will be issued. Expenses incurred for medical treatment rendered outside of the UHS for which no prior approval or referral is obtained are excluded from coverage.
A UHS referral for outside care is not necessary only under the following conditions:
- Medical Emergency
- When the Student Health Center is closed
- When service is rendered at another facility during break or vacation periods
- Medical care received when the student is more than 20 miles from campus
- Medical care obtained when a student is no longer eligible to use the Student Health Center due to a change in student status
- Psychotherapy; or
- Services not offered by the Student Health Center
Students insured with the UNC Student Health Insurance Program will pay $20 for a regular visit to the Student Health Center. The $20 will cover the office visit and simple care. You will not be subject to the $500 deductible for care received at the health center. (Lab work at the SHC will still be subject to the deductible).
Will the UNC Student Health Insurance cover charges from my family doctor at home?
Yes, provided they are for covered expenses. Your UNC Student Health Insurance is good any where in the world. However, some providers may request that you pay for the charges and submit the charges to the insurance company for reimbursement, rather than billing them directly.
I am graduating in May. Will my UNC insurance end at graduation?
No. If you are covered by the UNC Student Health Insurance Plan for Spring Semester of the academic year, your coverage will be in force until the end of that plan year (August 16 at 12:00am), even if you graduate. This means that paying your Spring Semester coverage will give you coverage over that entire summer.
Is my UNC Student Health Insurance good when I am home at Christmas?
Yes. Paying the premium for Fall Semester gives you coverage from August 17 through December 31, 2015. Spring coverage takes effect January 1st, 2016 and you are automatically enrolled in coverage if you haven't waived the premium for fall and you are taking at least 9 credits for undergraduates and 6 credits for graduates.
I filled out a waiver last Fall, do I have to do a new one again this year?
Yes. A new waiver is required from EVERY UNC STUDENT that has comparable coverage every academic year. This is because many people change jobs during the course of a year, and their insurance coverage may change. This assures the University of having up-to-date insurance information from each student.
Who do I pay my deductible to?
The deductible is paid to the provider supplying the covered service(s). You do not pay the deductible to the insurance company or the university.
After you receive your Explanation of Benefits (EOB) from the insurance, you will be able to tell which provider you need to pay the deductible to.
The first claim(s) for covered expenses that you submit for
processing will be applied to your deductible.
Once you have reached the deductible amount, the insurance will begin reimbursing covered expenses at 80% (PPO) or 50% (non-PPO)
If you are seen in the Student Health Center, you do not have to meet the deductible. You will pay a $20.00 copay and the insurance will pay covered expenses at 100%.
Can I submit receipts from the antibiotic I took for strep throat to the insurance?
The UNC Student Health Insurance Plan is part of HealthSmart RX pharmacy network. This means in order to receive coverage for prescription medications you MUST use a HealthSmart RX pharmacy to obtain prescription medications. Please see the policy booklet or the section on Prescription Drugs for further information regarding coverage for medications.
What is an out-of-pocket maximum?
This is the maximum amount of money the student has to pay for claims per plan year. The out-of-pocket maximum for 2014-2015 is $6350.00. After the deductible has been met, the plan will pay 80% for PPO and 50% for non-PPO.
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