Student Health Insurance Administrative Procedures and Guidelines

Last Modified: Tuesday, October 3, 2023 2:06 pm

Student Health Insurance Administrative Policy, Procedures and Guidelines PDF

Student Health Insurance

Montclair State University values the health of its students and remains dedicated to offering all students access to quality healthcare and affordable health insurance plans to aid in protecting against financial hardships that may stem from high healthcare expenses. While most of our undergraduate and graduate students are in good health and face few severe illnesses while in school, medical and psychological issues can emerge at any time, occasionally without warning. Many health concerns may not become apparent initially until early adulthood.

The high cost of healthcare in the United States exemplifies a potentially severe financial risk to students. The scarcity of adequate insurance coverage can result in transient or enduring interruptions in students’ academic achievements. Therefore, Montclair State University requires all students registered as full-time** (as defined below) to maintain health insurance.

  • Undergraduate students enrolled in twelve (12) or more credits. **
  • Graduate students enrolled in nine (9) or more credits. **

In addition, all F-1 visa holders, part-time or full-time, will be required to maintain health insurance coverage.

Most students are automatically charged a health insurance premium as part of the course registration process. To ensure waiver compliance, students will have the opportunity to waive/opt-out of the Student Health Insurance Plan (SHIP) by providing evidence of a comprehensive Affordable Care Act (ACA) compliant health insurance plan online to our third-party broker University Health Plans (UHP).

Section 1.0 - Student Health Insurance Charge Guidelines

Montclair State University requires all domestic undergraduate students enrolled in 12 or more credit hours, domestic graduate students registered in 9 or more credit hours and F1 and J1 students (part-time or full-time) to carry health insurance coverage.

In keeping with our institutional responsibility to protect the health and well-being of our students, Montclair State University requires all domestic undergraduate students enrolled in 12 or more credit hours, domestic graduate students registered in 9 or more credit hours and F1 and J1 International students meeting any of the above-referencing criteriums to maintain health insurance coverage throughout the academic year. The University’s stance regarding health insurance aids in protecting our students against unexpected high medical costs and ensures quality care while at school or traveling abroad. Montclair State University automatically charges Student Health Insurance to any registered student who meets the criteria listed below:

Fall Term

  • Undergraduate students carrying twelve (12) or more credit hours in the Fall semester.
  • Graduate students carrying nine (9) or more credit hours in the Fall semester.
  • F1 and J1 students registered part-time or full-time.

Spring Term

  • Any “New” (was not here for the Fall term or was part-time in the Fall term) Undergraduate student carrying twelve (12) or more credits in the Spring semester.
  • Any “New” (was not here for the Fall term or was part-time in the Fall term) Graduate student carrying nine (9) or more credits in the Spring semester.
  • Any “New” F1 and J1 students (was not here for the Fall term or was part-time in the Fall term) enrolled for any number of credits in the spring term.

Doctoral students completing their dissertations that wish to enroll in the University-sponsored Student Health Insurance Plan may petition by emailing Danisha Goodman at Please note that this petition will assess the “Student Health Insurance” premium with the understanding that the student will remain enrolled in coverage until the policy termination date.

Section 2.0 - Student Health Insurance Site Opening / Closing Guidelines

The Student Health Insurance waiver/enrolment site will open on or around mid to late July for the Fall term and close on or around mid to late October. The waiver site will open on or around mid-December and close on or around mid to late March for the Spring term. All students will receive a general email blast notification informing them that the website site is open, outlining the criterion for waiving/enrollment the school-sponsored health insurance and highlighting the established deadline. We will send targeted email communication to students after the specified deadline and the inception of the Late Waiver Appeal Period. Students who fail to act during the open waiver/enrollment period or the Uncontested Late Waiver Appeal Period will be enrolled into the Health Insurance Plan and become financially responsible for the associated cost of the Health Insurance Premium.

Section 3.0 - Student Health Insurance Waiver Deadlines Justification

Montclair State University establishes waiver and appeal deadline(s) to comply with its contractual and financial obligations to the school-sponsored health insurance provider (Aetna Student Health). The Health Insurance Fees are itemized charges on a students’ account/invoice which are emailed to students on the 1st and 15th of each month during the course of a semester or term. We notify students of the waiver process through internal and external email communications, acceptance materials orientations, divisions/advisors, emails, the university website, etc. Ultimately, it is the students’ responsibility to verify the account’s accuracy and the timely application of waivers. That said, we strongly advocate for our students to periodically monitor their accounts via Nest and Self-Service Banner (SSB) and their Montclair State University email account, as it is the primary source of itemized account/billing information and student communication.

Section 4.0 - Student Health Insurance Waiver Guidelines

4.01 Domestic Students

All domestic students may opt to waive coverage under the Student Health Insurance Program (SHIP) if they have health insurance that meets the plan requirements listed in the Waiver Requirement Student Checklist. Students will need to provide information about their current coverage via the University Health Plans website to initiate the waiver process. Accepted waivers apply only to the academic year in which it is filed. Waivers typically process within five (5) to seven (7) business days after submission. Students not charged the student health insurance fee do not require the completion of a waiver. Students are responsible for viewing their accounts to verify the occurrence of the assessment before attempting to waive.

4.02 International Students

Montclair State University will enroll all F-1 and J-1 international students into the school-sponsored health insurance plan. They may only opt-out (waive) if proof of coverage by an ACA-compliant insurance provider, filed and approved in the U.S. is provided. Typically, we will not support plans marketed solely to international students as they do not fall in the category as accepted comparable alternative coverage (please verify before purchase). They are often not filed and approved in the U.S. and have limited benefits, provider networks and coverage periods that do not comply with the requirements of acceptable coverage per the Montclair State insurance mandate. GBG Insurance, HDL Global Specialty, ISO, PGH (United), PSI, Student Medicover and Tata AIG are examples of companies that do not meet the waiver requirements. J-1 visa holders must meet the U.S. Department of State’s health insurance minimums.

International students that have a health insurance plan that meets all of the waiver requirements can request the International Student Waiver Form by contacting University Health Plans at 800-437-6448 or

Section 5.0 - Student Health Insurance Waiver Approval Guidelines

Students who meet all of the waiver criteria will be eligible to opt-out of the school-sponsored health insurance plan (SHIP). Once the waiver is accepted, verified and approved by University Health Plans (UHP), a credit (in the form of a waiver) totaling the amount of the health insurance charge will be posted to the student’s account within five (5) to seven (7) business days. If the waiver application results in a credit or overpayment, the system will automatically process a refund within seven (7) to fourteen (14) days (provided this does not occur within the refund blackout periods).

Section 6.0 - New Jersey Family Care (NJFC) Waiver Guidelines

Students who receive their coverage through New Jersey Family Care (NJFC) will be allowed additional time to provide documentation as we are aware that the New Jersey Family Care (NJFC) application process takes a minimum of 60 to 90 days after applying. Therefore, students falling into this classification must adhere to the following deadlines and criteria:

Fall Term

  • Proof that NJFC coverage begins September 1 or sooner.
  • Complete SHIP Waiver Appeal by November 30.

Spring Term

  • Proof that NJFC coverage begins February 1 or sooner.
  • Complete SHIP Waiver Appeal Form by April 30.

Students that accumulate claims during the time of SHIP enrollment cannot the SHIP coverage removed.

Section 7.0 - Student Health Insurance Waiver Appeal Review Board (Shi-Warb)

Comprised of the Lead Administrator, who facilitates the daily operations of the Student Health Insurance waiver/enrollment process, the Director and Associate Director of the Office of Student Accounts and the AVP of Finance, make up the Student Health Insurance Waiver Appeal Review Board and are charged with reviewing all uncontested/contested Late waiver appeal requests.

Please Note: Appeal requests (uncontested or contested) that exceed twenty-five (25) days from the official waiver deadline date will not be accepted. All decisions are final.

Section 8.0 - Student Health Insurance Late Waiver Appeal Guidelines

Students who do not waive the school-sponsored health insurance plan before the deadline have the option to submit a Late Waiver Appeal Form via University Health Plans (UHP). The late waiver appeal guideline consists of two levels; uncontested and contested. All waivers are subject to review by the “Health Insurance Waiver Appeal Review Board”. The guidelines of both are outlined below.

8.01 Uncontested Late Waiver Appeal Guidelines

The Office of Student Accounts will establish an “Uncontested Late Waiver Appeal” which shall be known as the “Waiver Deadline Appeal”. The length of the uncontested late waiver appeal (Waiver Deadline Appeal) period will be based on any outside determinants that may contribute to the likelihood of students failing to act to waive the school-sponsored health insurance but shall not exceed twenty-five (25) days from the official waiver deadline date. A final determination regarding the length of this period will occur after careful consideration of these determinants and approval by the Director of the Office of Student Account with actions ensuring compliance carried out by representative(s) from University Health Plans, the Student Health Insurance Administrator and other individuals as deemed necessary. Examples of some such detriments taken into consideration are but are not limited to:

  • COVID-19 Pandemic & Re-acclimation to In-Person Classes/Activities
  • Incoming Freshmen Population
  • Number of Non-Responders (student who did not act)

Any student wishing to submit a Waiver Deadline Appeal during the Uncontested period must:

  • Complete a Late Waiver Appeal Form
  • Submit proof of health insurance in the form of an insurance ID card or a letter from their insurance carrier
  • Clearly state the reason for requesting a late waiver

Once submitted, University Health Plans (UHP) and the Student Health Insurance Administrator will:

  • Confirm that insurance meets the waiver criteria
  • Confirm the submitted documentation is acceptable

If the student meets the requirements and standards mentioned above, the SHI Waiver Appeal Review Board will approve the “Waiver Deadline Appeal”.

8.01 Contested Late Waiver Appeal Guidelines

The Student Accounts Office defines a “Contested Late Waiver Appeal” period as any time after the “Uncontested Late Waiver Appeal” or Waiver Deadline Appeal period. If a student contacts University Health Plans or any Montclair State University Office during the contested period, we will inform them that the Official Waiver Deadline and Waiver Deadline Appeal have passed and we can no longer accept or review any requests. However, if a student believes they have extenuating circumstances that caused them to miss the deadlines and warrants additional review or if a student feels the assessment was unjust, they must submit a formal appeal via University Health Plans.

Extenuating circumstances can vary for students, but some examples warranting allowance of a Contested Late Waiver Appeal are but limited to:

Pre-existing condition, severe/debilitating illness or accident.
Involuntary call to active military duty.
Late or Back Dated Registration.
Disruption or Interference in current medical coverage or medical treatment.
Other extraordinary/emergency circumstances, such as natural disasters.

If the reason offered by the student is deemed sufficient to justify approval of their “Contested Late Waiver Appeal,” (as determined by University Health Plans (UHP) and representative(s) within the Office of Students, an approval will be granted based on extenuating circumstances as a one-time courtesy. In that case, the waiver will take effect for the term in which the student submitted the “Contested Late Waiver Appeal”.

It is essential to note the following about the Student Health Insurance Contested Late Waiver Appeals process:

Missed deadlines will not be sufficient for an appeal as Montclair State University and University Health Plans communicate deadline information via email with students.

Missed/disregarded email communications from any Montclair State University Office will not be sufficient for an appeal as per University Policy; students must familiarize themselves with the contents of all official University notifications and react accordingly to guidance dictated in the correspondence and reply to those requiring a response.

Health cost-sharing plans are not considered comparable coverage as all insurance plans must be fully compliant with the Affordable Care Act (ACA) provisions and provide access to local primary care providers in the Montclair State University area. Contested Late Waiver Appeals will not be approved solely based on having comparable alternative health insurance coverage.

Students have thirty (30) days after the waiver deadline to file a Late Waiver Appeal. We will notify students of the final decision no later than two (2) weeks after their submission date.

Section 9.0 - Early Termination (Not Permitted)

Montclair State University / Aetna Student Health does not prorate health insurance premiums or adjust effective dates of coverage. We will not remove students from SHIP coverage based upon graduation, withdrawal from the University or new insurance plans post waiver deadline. If you are enrolled (opt-in or forced), the coverage will remain in effect until the policy’s termination date (typically on or around mid-August unless otherwise specified).

Section 10.0 - Guideline For Enrollment After Waiving The Student Health Insurance Plan

10.01 Qualifying Life Event

If a student waives the school-sponsored health insurance plan but later experiences a change in coverage or Qualifying Life Event (QLE), the student may petition Aetna Student Health directly to enroll. For no lapse in coverage to occur, an application and documentation (proof) must be submitted (directly to Aetna Student Health) within 30 days from the onset of the QLE date.

Examples of Qualifying Life Event (QLE) include but are not limited to:

  • Change in marital status.
  • Loss of employment.
  • Loss of insurance coverage.
  • Turning age 26.

Please Note: the student’s application is subject to review and approval by Aetna Student Health, provided the student meets the specified criteria outlined on the Qualifying Life Event Enrollment Form. If a student is granted enrollment under the basis of a Qualifying Life Event, Aetna Student Health will use the daily QLE rate to calculate the cost of the students’ policy and the student will be responsible for remitting payment directly Aetna Student Health.