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Student Health Insurance Frequently Asked Questions

1. Why did AU change student health insurance providers?

We’ve transitioned to CareFirst to provide more health benefits while keeping the cost of coverage down.

The premium for 2019-2020 is $1,890, which is equivalent to a monthly payment of $157.50. That’s a lower price than last year’s premium under our previous provider, with expanded benefits, including:

  • Students no longer need a referral from the Student Health Center for specialty care in the community
  • Students have access to a larger network of mental health providers

2. Must I be on the AU-provided health insurance (CareFirst)?

No. Although enrollment in the CareFirst plan is automatic, you are free to waive coverage in favor of a provider of your choice, as long as the coverage is valid for use in Washington, DC and meets AU's criteria for comprehensive coverage. The premium is billed automatically, but once your waiver is approved, the premium charge is removed from your bill. You may waive through Sept. 20, 2019.

3. Is AU managing the insurance plan?

No. AU has contracted with CareFirst as the insurance provider to manage the plan. The insurance plan is NOT being managed by AU or the Student Health Center.

4. Does AU have new health insurance requirements?

No. The university has had a mandatory policy for over two decades that requires all full-times students to have comprehensive insurance that is valid for use in Washington, DC.

5. If the policy isn’t new, what changed?

What’s new is the extra layer of confirmation. Waiver requests now are reviewed before being granted, so that if students submit an alternative policy and report that it is comprehensive and valid in Washington, DC, this can be confirmed.

The discussions about waiver reviews occurred in the months prior to CareFirst being chosen as the vendor. Even if the university had stayed with the previous provider (United Healthcare), the review process would have been implemented.

6. Why are waiver requests being reviewed?

In the past, a number of students who provided alternative insurance plans and received a waiver experienced serious medical issues, faced large medical bills and/or were unable to afford medication. It is important for students to have valid, comprehensive insurance that covers them in case of medical need.

Additionally, some students without adequate health insurance coverage in Washington, DC needed to travel back to their home states in order to get the care they needed. This resulted in unanticipated travel costs as well as missed time in classes, internships and work. Their inability to get their medical condition treated in Washington, DC put their medical, academic and financial health at risk.

7. How do I request a waiver?

  • Click on the following link: https://member.carefirst.com/mos/#/registration/home1

  • Follow the directions to create an account. (Although the page is called Registration, please be assured that this does NOT enroll you or make you a CareFirst member; it creates an account that enables you to waive.) Create an Alternate ID/Student ID by entering the letter A, the number 0, and your 7-digit AU student ID number in the box (A0*******); your date of birth; and continuing the steps.

  • You then must submit proof of coverage by another health insurance provider. You do this by uploading either a copy of your insurance card in PDF format or a document from your insurance carrier showing you have coverage in PDF format.

  • You will receive a message from CareFirst that you’ve submitted the waiver. This does not mean that it was approved; that decision will be made within 5 business days.

8. My waiver request was denied. Why?

If it was denied, you didn’t demonstrate that you have comprehensive insurance that will cover you in Washington, DC. You must be able to show that it meets the criteria. If you believe your waiver was denied in error, you may appeal.

9. But I received a waiver before. Why was a waiver denied this time?

If you waived before with the same insurance and are denied a waiver now, there are several possible reasons:

· You previously waived with a plan that did not have comparable coverage. The process now goes beyond self-reporting to include a review of waiver submissions, which confirms if you are covered under the comparable coverage requirements.

· You did not provide enough documentation of your insurance to demonstrate that it provides comprehensive coverage. You can provide this documentation in an appeal.

10. I’m on Medicaid. Why was my waiver denied?

Medicaid coverages can differ by state. But Medicaid in one state does not typically provide comprehensive coverage to a resident who is out of state. Your waiver request will be denied if Medicaid does not cover you in Washington, DC. If you have no comprehensive coverage in Washington, DC, you are vulnerable to financial risks.

11. I can’t afford health insurance. What do I do?

Financial aid recipients concerned about covering the cost of AU health insurance due to a waiver denial should contact the financial aid office to explore alternative financing options. Please speak with your designated financial aid counselor.

12. How is equity being addressed?

Students who opt to use the CareFirst plan now pay a lower premium than last year, while receiving more benefits. We have been very mindful of affordability in transitioning to CareFirst. In addition to lower costs, we have also worked with the provider to ensure the plan has the level of benefits students need.

Unexpected medical bills can easily mount to thousands or tens of thousands of dollars. If a student receives a waiver, only to find later that their insurance plan does not cover them fully in Washington, DC, they risk facing extreme financial burdens that have a disproportionate impact on low income students.

13. I’m covered for emergencies. Why can’t I be allowed to waive?

Our policy mandates comprehensive care, which goes beyond emergencies and covers medical costs that result from many non-emergency situations. In accordance with our policies, students cannot attend AU and be uninsured or underinsured. Students who waived in the past believing their coverage was adequate have found themselves saddled unexpectedly with significant medical bills.

Please be aware that situations many people would consider an “emergency” may not be defined as an “emergency” by a health insurance provider and would not necessarily be covered. Follow-up care, ambulance transportation, and psychiatric care are examples of scenarios that can cause medical bills to quickly reach thousands of dollars if you lack comprehensive coverage in Washington DC.

In addition, serious symptoms (such as chest pains or a fever) could reasonably send a student to the emergency room. But if these turn out not to be symptoms of a serious illness, the lab tests, specialists’ consultations, and other emergency charges will not be covered unless the plan offers comprehensive coverage in Washington, DC.

Our core concern is ensuring that students have adequate coverage so that their health and education are not jeopardized when serious health issues arise.

14. Who sets the mandatory coverage policy?

This policy is set by AU, not by the Student Health Center or the health care provider. It follows nationally accepted standards and best practices in higher education. To the best of our knowledge, all other major universities in Washington, DC have a similar requirement.

15. I believe my waiver was denied in error. How can I appeal?

Email CDSHPSHP1e-mails@carefirst.com

This is the dedicated email inbox CareFirst has created for students who believe their waiver request was denied in error and need an urgent resolution.

You MUST be able to document that your insurance includes the following in the Washington, DC area:

  • Lab work
  • Medications
  • Specialty referrals
  • Urgent care visits
  • Mental health services (psychotherapy)

This may need to be in the form of a letter provided by the insurance provider.

Here’s what you will need to provide with your email:

  • Name
  • Student ID
  • Proof of insurance (front and back of insurance card and/or insurance policy in PDF format)
  • Name of current insurer
  • Type of policy
  • A call-back number
  • Name of contact, if someone other than the student is making the appeal (such as a parent)
  • A letter from the insurance provider, as noted above, is strongly suggested

16. I’m having problems with the CareFirst site. How can I find help?

Call 844-898-3332 to reach the customer service team that CareFirst has dedicated to American University. You can reach this team Monday-Thursday 8 am-5 pm and Friday 10 am-5 pm EST. PLEASE DO NOT CALL OTHER CUSTOMER SERVICE NUMBERS.

Here are the steps you should follow to get through:

  • Call 844-898-3332
  • This takes you initially to a general automated CareFirst menu. We understand this can be confusing – particularly as you will first be asked for a member ID (which, if you’re trying to register, you won’t yet have.)
  • Say “representative” to get through this automated menu and be transferred to a dedicated team member.
  • You may need to repeat “representative” several times. You may also be put on hold as you are being transferred to the team.

We recognize that challenges with the site can be frustrating and hope that, as issues are resolved, students will not encounter technical problems.

Realize also that problems in using the site can be due to user error. Please read directions carefully, refer to these FAQs for guidance, and call 844-898-3332 if you need assistance.

17. I’m an international student. Can I waive?

Most international students cannot waive and must be covered by AU’s student health insurance plan.

Please see information for international students on insurance and insurance waivers.

18. I’m a part-time or online student. Do I need to waive?

No. Part-time or online students are not automatically enrolled in this insurance, so do not need to waive.

However, you can opt in if you are taking at least 6 credit hours. To request enrollment, please send an email to shc@american.edu with your name and AU ID number. We’ll verify the number of credits you’re enrolled in and then guide you through the process.

19. Can AU submit my information on my behalf?

No. This can only be done through CareFirst and its site.

20. I have another question.

Please first check the following messages to see if they address your question:

Key Information about AU’s Student Health Plan, including FAQs

Criteria: What a Plan Must Include to Be Comparable

About the Student Health Insurance Plan

If you have questions about the CareFirst benefits under this plan, information can be found at:

CareFirst Health Insurance Site for AU Students

For questions and guidance on the waiver process, please call the CareFirst representatives at the dedicated line for the AU community: 844-898-3332

You may also contact the Student Health Center at shc@american.edu or the Office of Campus Life at campuslife@american.edu