Creating the Extraordinary Student Experience

Qualifying Events for the SHI Benefits Plan

How to request a student health insurance change due to a Qualifying Event:
  • Submit a Coverage Status Change Form within 31 days of the date of the Qualifying Event. Forms submitted past 31 days will not be processed. 
Qualifying Events: Definition and List

A life event that allows a 31-day window to ask to modify an existing selection or waiver:  

  • You experience an involuntary loss of eligibility for health insurance benefits 
  • You age out of coverage as a dependent through a parent's plan
  • You, your spouse, or your parent experience an employment change (for example, a new hire) that provides a new opportunity to enroll in employer-sponsored health insurance. **Note: You should contact our office within 31 days of the hire date, regardless of when your employer-sponsored health insurance will begin**
  • You get married and wish to add your new spouse to your SHI Benefits Plan coverage, or you gain new eligibility through your new spouse and wish to terminate your SHI Benefits Plan coverage
  • You have a newborn or newly adopted child you wish to add to your existing SHI Benefits Plan coverage
  • You get divorced and as a result you involuntarily lose your other coverage, or you need to terminate your existing SHI Benefits Plan dependent coverage, or you are legally mandated to newly provide coverage for an eligible dependent
  • You newly attain minimum eligibility after the second Friday of the academic term
  • Your dependent has a first time arrival to the United States from a foreign homeland
  • Your dependent returns to a foreign homeland
  • Your spouse, child, or other dependent, dies
  • You declare or terminate a Domestic Partnership
Review and Approval Process

SHI issues an approval or denial based on compliance with the deadline and documentation requirements. When your approved request goes into effect depends on whether you are asking to add or drop: 

  • To ADD coverage, coverage will become effective the day of the Qualifying Event. A pro-rated fee will post to your Statement of Account.
  • To DROP coverage, coverage will terminate on the first day of the following coverage period and there will be no prorated refund of your fee.
The following are NOT Qualifying Events for student health insurance:
  • An "Open Enrollment" period for an insurance policy 
  • The loss of a university subsidy or a change in personal financial circumstance 
  • Purchasing other health insurance after the Select/Waive deadline of your first term in an academic year
For students who applied for Medicaid prior to their first SHI Select/Waive deadline of the year: 

We recognize students with pending Medicaid applications may select the SHI Benefits Plan while awaiting Medicaid notification. If a student is retroactively approved for Medicaid coverage and can document that they applied for Medicaid before the Select/Waive deadline of their initial coverage period of the academic year, they can submit a Coverage Status Change request to retroactively change their selection to a waiver, per the following:  

1. Students must submit the following to SHI within 31 days of when they received Medicaid notification:

  • A completed Coverage Status Change Form
  • A copy of the Medicaid Notice of Action Letter showing the date you applied and the date the issued coverage was effective
  • A copy of your Medicaid Eligibility Portal screen shot

2. Students must have submitted their Medicaid application prior to the Select/Waive deadline of their initial coverage period. For example, if you meet insurance requirement eligibility in Autumn 2017 semester, you must have applied for Medicaid before the Autumn Select/Waive deadline of 8/15/17.

When items 1 and 2 above are met, approvals will be issued as follows:

  • If the SHI Benefits Plan has not paid claims on behalf of the student or student’s covered dependents, the Waiver will be granted retroactively to the start of the initial coverage period.
  • If the SHI Benefits Plan did pay claims on behalf of the student or covered dependents, the Waiver will be approved for the coverage period subsequent to the student’s initial coverage period. This may mean the student will retain both Medicaid and SHI Benefits Plan for a time period. Optional: If the student takes action to work with the SHI Benefits Plan Claims Administrator and their Medicaid Plan to resubmit the paid claims to Medicaid and reverse the SHI Benefits Plan payments, SHI can consider approving a Waiver for the initial coverage period.
Annual Selection Reminder

Outside of Qualifying Events, your Select/Waive choice at the start of your first term stays in effect for a standard period of time. If you select the SHI Benefits Plan, it is effective for the entire policy year and you cannot modify your choice term-to-term. If you waive the SHI Benefits Plan, the waiver will stay in place for the entire policy year; you can, if you wish, newly Select the SHI Benefits Plan for a subsequent coverage period within a policy year.