Using Insurance at UNC Health Campus Care

Affordable Care Act – The Affordable Care Act is the comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010, and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.

Certificate of Creditable Coverage – There may be circumstances where your insurance carrier will require proof that you were covered in the previous 12 months by another insurance company in order to waive a pre-existing condition.  The certificate will show the effective and termination dates of your previous insurance policy. 

Certificate of Verification – A certificate from an insurance carrier defining the policy coverage dates for a plan you have not yet terminated or canceled. This certificate is used to show that you remain covered under a specific plan and would not show a termination date.

Co-insurance – Co-insurance means the insured person (you) and the insurance carrier share costs according to a specified ratio (such as 80%:20% or 70%:30%) of the hospital or medical expenses resulting from a sickness or injury.

Co-Payments (co-pay) – Payments made by the insured person (you) toward the cost of a particular benefit. For example, the current hard waiver student insurance plan effective August 1, 2022, requires a $35 co-pay for office visits and $70 co-pay for specialist visits for services received outside UNC Health Campus Care (questions regarding specific charges should be addressed to BCBS). There is a $75 co-pay for Urgent Care appointments. An emergency room visit has a separate $500 co-pay. This encourages students to make an informed decision on Emergency Room visits.

Covered Benefit – A covered benefit is a medical service or procedure, prescription, immunization, x-ray, etc. that your insurance carrier will consider for payment. Depending on your specific insurance policy, your insurance carrier may not pay a covered benefit until you have satisfied (paid) your deductible, co-pay, or co-insurance and the payment of a covered benefit may apply differently at an in-network and out-of-network clinician.

Covered Illness/Sickness – A covered illness/sickness is any disease, infection, or condition other than an injury that is first treated or diagnosed by a doctor on or after the effective date of coverage under the insurance plan unless pre-existing condition waivers apply.

Covered Injury – A covered injury is an accidental bodily injury that causes loss – directly and independently of all other causes – and is sustained on or after the effective date of coverage under the plan, unless pre-existing condition waivers apply.

Deductible – A deductible is the amount of out-of-pocket expenses the insured person (you) must pay for health services before benefits become payable by the insurance carrier.

EOB or EOP – This is an Explanation of Benefits or Explanation of Payment. Your insurance carrier provides this information for each claim submitted. It explains how the payment was made for each claim. Sometimes the EOB or EOP will request additional information to continue processing a claim. EOB’s should be reviewed carefully.

Formulary – A list of prescription drugs, both generic and brand name, that are preferred by your insurance company.

Generic Drug – A drug that is the same as a brand-name drug in dosage, safety, strength, how it is taken, quality, performance, and intended use.  Before approving a generic drug product, the FDA (Federal Drug Administration) requires many rigorous tests and procedures to assure that the generic drug can be substituted for the brand name drug.

Grandfathered Health Plan – A health plan that was created, or an individual health insurance policy that was purchased on or before March 23, 2010, and the written policy has not changed. Grandfathered plans are exempted from many changes required under the Affordable Care Act.

Hard Waiver – Health insurance is required as a condition of enrollment.  Students may waive the UNC System Student Health Insurance Plan but must provide proof of existing creditable insurance coverage.

Insurance Payment – Your insurance policy must be in effect at the time of services for your insurance carrier to consider any services for payment. Treatment before your effective date or after your termination date will not be paid.

In-Network Provider – An in-network provider has contracted with your insurance carrier to take an adjustment (reduce the amount you have to pay the provider). The adjustment will vary depending on your insurance policy.

Non-Formulary – Drugs that are not on the insurance companies’ list of preferred drugs.  This would be an extra cost to the patient.  Usually, there is an alternative option of the drug that can be used or prescribed by your physician.

Out-of-Network Provider – An out-of-network provider is not contracted with your insurance carrier and is not required to give an adjustment.

Pre-Existing Condition – A pre-existing condition is an injury, illness, or pregnancy for which medical care, treatment, diagnosis, or medical advice was received or recommended or medication was prescribed prior to the effective date of the insured person’s coverage under the insurance plan. The current student insurance plan limits pre-existing conditions to within six months prior to the plan effective date. 

Primary Care Physician (PCP) – A physician, nurse practitioner, clinical nurse specialist, or physician assistant, who provides, coordinates, or helps you access a range of health care services.

Qualifying Life Event – If you have a life event similar to the ones listed, you may be able to enroll in insurance outside of the normal open enrollment period. You have a 30-day deadline to enroll after the Qualifying Life Event.

• get married
• have a baby, adopt a child or place a child for adoption
• gain citizenship
• gain/lose a dependent
• move out of current insurance coverage area
• aged off parent’s insurance
• get divorced
• graduate and lose school insurance
• Cobra expires
• loss of work insurance

Referral –  A referral happens when students require services that cannot be provided at UNC Health Campus Care. The Referral Coordinator arranges the referral with service providers in the student’s insurance network when possible.

Specialist – A physician who focuses on a specific area of medicine.

For additional definitions visit BCBS at: http://studentbluenc.com/#/uncch/welcome

Many insurance plans offer a prescription card benefit program. Campus Health Pharmacy and Student Stores Pharmacy participates in most of these plans.  A complete Campus Health Pharmacy and Student Stores Pharmacy formulary is available on the Pharmacy Services webpage.

By default, UNC Health Campus Care bills your insurance company for services you receive. Typically, insurance companies send an explanation of benefits to the insurance policy holder (the main person on your insurance plan) when there are charges. The Explanation of Benefits includes a date of service, who provided your care, a description that explains what service you had like a medical visit, lab test, or screening, the cost of your care, how much the insurance company will pay, and the amount, if any, that you owe.

The UNC System does not currently endorse a dental insurance plan.

You can research dental insurance options on your own. Dental insurance generally covers two cleanings per year and then a percentage of the cost of fillings, crowns, x-rays, extractions, and other dental procedures based on the policy benefits.

Most dental insurance policies have a waiting period before you can receive any extensive care such as an extraction or crown. For example: If you need your wisdom teeth pulled, you may have to wait six (6) months after purchasing your dental plan before having the procedure done. This depends on the nature of your coverage, so read through the policy benefits carefully.

Once you have insurance and before you visit the dentist, ask your dentist the following questions: 

• Do you file dental insurance claims? If so, how quickly do you file them? 
• Are you in-network with my insurance? 
• Can you help me understand my financial responsibility for my dental needs? Be clear on your financial responsibility before you have a procedure done. You can ask the dentist to provide you with a quote based on your insurance benefits.

Some options to consider:

• Dental care is offered in the James A. Taylor building by Campus-Smiles, and Campus-Smiles has partnered with a low-cost dental insurance plan. Campus-Smiles accepts all major PPO dental insurance plans. 
• The General Alumni Association partners with a dental insurance plan that’s being offered to current Carolina students as well as GAA members.

UNC Health Campus Care is unable to file claims with an international insurance company, but can provide the necessary paperwork for the student to file their claims.

To waive, an insurance policy must be effective (active) on or before September 1 for the fall semester and on or before February 1 for the spring semester.

Beginning January 1, 2026, International students holding F-1 or J-1 non-immigrant statuses are required to
participate in the UNC System Student Health Insurance Plan (SHIP) and are not able to opt out of the medical plan without specific conditions. Please read through the FAQ’s attached below for more information.

Students who want to participate in the Student Blue Insurance Plan should enroll each semester before August 1 or January 1 to activate the insurance. You activate the insurance each semester before you need an immunization, prescription or have other medical needs.  The Student Health Insurance charge will be on your University account.

There are requirements by the UNC system on international students and their health insurance. 

Eligible students are enrolled by their individual academic departments in the RA/TA Graduate Student Blue Health Insurance Plan (GSHIP). Most UNC Health Campus Care charges not covered by the Health Fee are covered by the RA/TA Health Insurance Plan and claims are billed directly to BCBS by UNC Health.

Benefits

For specific information about the RA/TA Student Blue Health Insurance Plan benefits go to the BCBS website for UNC-Chapel Hill RA/TA.

Prescription benefit

For information on prescription drug coverage see Campus Health Pharmacy Formulary. 

Payment for services

Charges incurred at UNC Health Campus Care not covered by the RA/TA Insurance Plan are the responsibility of the student and are transferred to the student’s account at the Office of Student Accounts and University Receivables in the Student and Academic Services Building (SASB) North. See Health Fee and Charges: Payment for Services for more information.

Dependents

To enroll a Spouse, Domestic Partner or Dependent you will need:

• Social Security Number
• Prior insurance information (insurer, policy number and dates of coverage
• An application – download the electronic application off the website

Termination

Verify with your department the termination date of your insurance policy. Most insurance companies will require that you contact them within 30 days of the termination of your RA/TA policy. It could take up to 45 days to apply for and begin a new insurance policy.

If your RA/TA health insurance is terminated on May 31, this is considered a qualifying event. You can contact a navigator at 800-318-2596 or BCBS (888-351-8283) directly to purchase the Student Blue insurance for the remainder of the spring/summer semester (June and July). 

Eligible individuals are enrolled by their individual academic departments in the PostDoc Student Blue Health Insurance Plan. Most UNC Health Campus Care charges not covered by the Health Fee are covered by the PostDoc Student Blue Health Insurance Plan and claims are billed directly to BCBS by UNC Health.

Benefits 

For specific information about the PostDoc Student Blue Health Insurance Plan benefits go to the BCBS Website for PostDocs,

Prescription benefit

For information on prescription drug coverage see Campus Health Pharmacy Formulary.

Payment for services

Charges incurred at UNC Health Campus Care not covered by the PostDoc Student Blue Plan are the responsibility of the PostDoc and an invoice is mailed to the PostDoc’s address on record.

Dependents

To enroll a Spouse, Domestic Partner or Dependent you will need:

• Social Security Number
• Prior insurance information (insurer, policy number and dates of coverage
• An application – download the electronic application off the website

Termination

Verify with your department the termination date of your insurance policy. Most insurance companies will require that you contact them within 30 days of the termination of your RA/TA policy. It could take up to 45 days to apply for and begin a new insurance policy.

Once your PostDoc insurance plan is terminated, a COBRA election form will be mailed to you, typically allowing the continuation of coverage for 18 months.  Election of COBRA must be made within 60 days of the date of notification.  Coverage is retroactive back to the termination date of the PostDoc insurance plan. Once your PostDoc insurance terminates you may enroll in an insurance plan through the healthcare exchange on the basis of a qualifying event. You may be eligible for subsidies based on income.  Individuals interested in an appointment with a Navigator can call 1-800-318-2596.

Students going abroad for a semester or a school year, either through an exchange or study abroad program, are automatically enrolled in GeoBlue Student Travel Health Insurance. GeoBlue is mandatory and you cannot opt out of this travel insurance. Please contact your program coordinator at the UNC Study Abroad office for GeoBlue insurance details.

Enrolling in health insurance for the first time can be very confusing. Terminology and fine print can make the task even more difficult when planning your insurance future. Young adults who go without health insurance may be one accident or illness away from a lifetime of medical bills and debt.  Health reform now requires most individuals to obtain health insurance or pay a tax penalty.

Laws make it possible for young adults to remain on their parent’s health care plan until their 26th birthday if the policy covers dependent children. This is true regardless of whether you are unemployed, looking for a job, married, in school, living at home, or even if you are employed, and your employer does not offer insurance coverage.

It is in the student’s best interest to have continuous health insurance coverage. A significant break in coverage could impact you significantly if you become ill, need a prescription, sustain an injury, or need to see a physician. Please note that it could take up to 45 days or more to apply for and enact comparable individual coverage. 

To avoid a lapse in coverage you may continue under a COBRA plan or consider purchasing an individual plan.  Check with your current insurance carrier well before your insurance terminates for information on deadlines and continuation plans.

For more information visit:

Researching Health Insurance Plans

HealthCare.gov for Young Adults

Healthy Young America Health Care

NCQA Health Insurance Plan Ratings

For GSHIP and the PostDoc Health Insurance Plan, your employer will enroll you in the plan. If you wish to enroll your spouse and dependents in this plan as well, review your UNC Postdoc BCBSNC Packet instructions and pricing.

RA/TA Spouse enrolls directly with BCBS for medical coverage, The per semester Health Fee is added to the bank draft along with the health insurance premium. Spouse must pay summer health fee direct to Campus Heath. 

Post Doc Spouse enrolls directly with BCBS health fee is paid directly to BCBS by bank draft each month for the entire FY which includes the summer.

Student Blue does not have dependent coverage.