5/12/2015

AetnaStudentHealth>WaiverApplicationConfirmation

Customer Service

Step 6

Transaction Confirmation

Yourwaiverhasbeensubmitted

Detailsofyourwaivertransactionareavailablebelow.

Print the confirmation

Your waiver application has been submitted. Please see the
confirmation below.

WAIVERHASBEENDENIED
Confirmation #: 2918705
Date: 5/12/2015
School: University of California, Berkeley
In order to waive enrollment in Berkeley SHIP, you must
have a private medical insurance plan that meets ALL of
the UNIVERSITY OF CALIFORNIA minimum health care
requirements:
Foreign insurance plans must have a contract written in
English, with benefits expressed in U.S. dollars and a U.S.
claims office. Travel plans and reimbursement plans are
not acceptable, including vouchers from home
governments or their U.S.-based consulates.
In order to be granted a Student Health Insurance waiver
you must have a health insurance plan that meets the
minimum benefits standard of UC Berkeley for the entire
SHIP term (Fall 8/15-1/14, Spring 1/15-8/14). The
information you submitted does not meet these
requirements.
Failed Waiver Criteria
The following are questions that failed your waiver
Does your health insurance plan have a benefit lifetime
maximum?
Does your health insurance plan cover all of the following
services:
a) Doctor office visits and treatment for medical, mental
health, and alcohol/drug abuse conditions?
b) Emergency room services?
c) Diagnostic services including laboratory tests?
d) Pre-natal and maternity care, with no pre-existing
condition limitation?
If your waiver was declined due to the OutofPocket
maximum: If you have a Health Savings Account (HSA) or a
Health Reimbursement Account (HRA) funded sufficiently
to reduce the total out-of-pocket expenses to $6,600 for
https://students.aetnastudenthealth.com/waiverconfirmation.aspx?groupID=474941

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5/12/2015

AetnaStudentHealth>WaiverApplicationConfirmation

an individual or $13,200 for a family please submit your

current financial institution statement with a Waiver
Appeal Form.
Please note that you will automatically be enrolled in the
Student Health Insurance Plan and your CARS account will
be billed.
TO APPEAL THE DENIED WAIVER: Your waiver was denied
because the information you provided was either
incomplete or does not meet the criteria required to
waive. You may complete the Waiver Appeal Form and
submit it as instructed within 10 business days from the
date of the denial.
You will be notified of the status within 30 days after
receipt of your completed appeal. Please submit your
appeal to the address, fax, or email below.
Mailing Address:
UHS-Student Health Insurance Office
2222 Bancroft Way, Room 3200
Berkeley, CA 94720
Fax: (510) 642-9119
Email Address: uhswaivers@lists.berkeley.edu

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Member Disclosure Legal Notices Find a Doctor or Hospital
77 South Bedford Street Burlington, MA 01803. Aetna Student Health Agency
Inc. is a duly licensed broker for student accident and health insurance in the
Commonwealth of Massachusetts. Massachusetts license number: 10041444.
California license number: OB84599.
Aetna Student HealthSM is the brand name for products and services
provided by Aetna Life Insurance Company and its applicable affiliated
companies (Aetna). Fully insured student health insurance plans are
underwritten by Aetna Life Insurance Company.
Self insured plans are funded by the applicable school, with claims
administration services provided by Aetna Life Insurance Company.

Customer Service Glossary FAQs Contact Us

https://students.aetnastudenthealth.com/waiverconfirmation.aspx?groupID=474941

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