Salem State University
STUDENT HEALTH INSURANCE PLAN

2012-2013 Academic Year

Dear Students,

Massachusetts Law requires that all students enrolled in at least 75 percent of a full-time course load at an institution of higher learning in Massachusetts must either provide proof of enrollment in a medical insurance plan that meets the Commonwealth mandated guidelines or be enrolled in a university-sponsored plan. Therefore, if you are a full-time or three-quarter time undergraduate or graduate student at Salem State University, you are required to have sufficient health insurance coverage while in attendance at the University.

The Salem State University Student Health Insurance Plan is provided by Blue Cross Blue Shield and administered by University Health Plans. The premium for the academic 2012-2013 year is $1,261 and the policy is in effect from August 1, 2012, through July 31, 2013.

To comply with State law, all students taking at least ¾ of a full-time course load MUST either waive out of or enroll in the Salem State University Student Health Insurance Plan online beginning the first week of July or three days after they are registered for a three-quarter or full-time course load by doing the following:

• WAIVE out of the Salem State University Student Health Insurance Plan online by clicking on the "Waiver Form" link on the left side of this page. You will be asked to provide information on your insurance coverage. To be eligible to waive out of the Plan, you must be currently enrolled in a health insurance plan with comparable coverage either as a dependent (on a parent's or spouse's plan), or through a plan you have at your place of employment or have purchased yourself. This will result in a credit reflected on your student account as Waiver Health Insurance $1,261. The deadline for waiving out of the Student Health Insurance Plan is September 30, 2012.

OR

• ENROLL in the Salem State University Student Health Insurance Plan online by clicking the "Enrollment Form" link on the left side of this page. You will be charged $1,261 for the insurance on your student account for the academic year 2012-2013. The deadline for enrolling in the Student Health Insurance Plan is September 30, 2012. By submitting the online enrollment form, you confirm your acceptance of the plan and expedite the processing of your insurance card. You may review the plan benefits by clicking on the "Brochure" link on the left of this page.

A Waiver or Enrollment Form must be submitted each academic year. Please take into consideration if your Health Plan offers coverage in the Salem/Greater Boston area before declining coverage. HMO plans based in states other than Massachusetts may have a limited network and limited coverage in the Salem/Greater Boston area.

IMPORTANT: All Students registered for nine (9) or more credits MUST go online and either WAIVE out of or ENROLL in the Student Health Plan by SEPTEMBER 30, 2012.

If you have any questions about health insurance waivers or billing, please contact the Bursar's Office at 978.542.6039. For questions about the Salem State University Student Health Insurance Plan, please contact University Health Plans at 800.437.6448.

Sincerely,

Salem State University