The requirements below must be met to waive SMC-SHIP. As you are completing the waiver, please be sure to read each question carefully and answer thoroughly . Please contact the Health and Wellness Center if you have any questions.
1. Will you be enrolled as a full-time undergraduate student at Saint Mary's College at any time during the 2015-2016 academic year?
2. Is your primary residence in the United States?
3. Is your plan provided by a company licensed to do business in the United States with a U.S. claims payment office and a U.S telephone number?
4. If you are enrolled in an employer-sponsored group health plan or individual plan, including plans purchased through Covered California, does it meet the following criteria?
i) Preventive health care services, including an annual physical exam, preventative, immunizations and laboratory/diagnostic tests to help determine your state of health ii) Chronic disease management for such conditions as asthma, diabetes or other chronic medical conditions
ii) Hospital stays for medical and surgical care
iii) Hospital stays for mental health and alcohol/drug abuse conditions, covered the same as any other medical condition v) Doctor Office visits for medical, mental health, and alcohol/drug abuse conditions
vi) Emergency Room services
vii) Diagnostic services including laboratory tests
viii) Medications prescribed by a doctor (including contraceptives)
ix) Pre-natal and maternity care, with no pre-existing condition limitation
x) Pediatric services, including oral and vision care
5. If you are covered by an HMO, is your HMO for primary care within the Bay Area (30 mile radius of campus)?
6. Does your plan provide unrestricted access to an in-network hospital and doctors providing full, non-emergency, medical and behavioral health care within 30 miles of campus or the student's place of residence while attending school?
7. Is your plan currently active and do you agree to maintain health insurance coverage throughout the entire 2015-2016 academic year?
8. Will you acknowledge and agree that you are responsible for payment of all fees for medical and mental health treatment not covered by your health insurance plan (including but not limited to deductible, co-pays, coinsurance and expenses above your policy maximums and benefit limits)?
To complete your application, you will need:
- Name of your insurance company
- Your policy number/member number
- Your company's customer service phone Number (back of your ID card)