HEALTH AND WELLNESS

Health Insurance and Health Care Providers

The University does not endorse any specific insurance plan, for convenience PNWU has established a student health insurance plan through Aetna, detailed information may be found on the Health Insurance webpage of PNWU.edu.

The student health insurance plan through Aetna is administered by Health Sciences Assurance Consulting (HSAC). All students will be charged for health insurance until/unless a waiver is approved. The policy start date is July 1 and terminates on June 30. For students who start their academic program later than July 1 the premium will be prorated, and the student will be enrolled based on their first day of classes or orientation, whichever comes first.

Waiver Requirements

If you have active health insurance with benefits that meets all of the criteria listed below, you may apply for a waiver of enrollment in the PNWU Student Health Insurance plan. You will need to have your current insurance ID card and information regarding your plan benefits to complete the process. You must go to HSAC’s PNWU portal to enroll in or to request a waiver. You must submit a copy of your Health Insurance ID card’s front and back with your request. Once you have submitted the required information, you will receive an email verifying if your waiver meets the PNWU waiver requirements. PNWU will not accept waivers past the required deadline.

The waiver deadline is the last date of the open enrollment period, June 30 for continuing students.

Acceptable Waivers

All students MUST be covered by an ACA-compliant domestic health insurance plan for the entire academic year, including summer and holidays.

Plans that qualify to waive the PNWU student insurance plan are:

  • Parent’s Employer Group
  • Spouse’s Employer Group
  • Partner’s Employer Group
  • COBRA – must provide proof of payment monthly
  • Veteran/Tricare Benefits
  • Washington Medicaid – Didactic Students only – must live in the state the entire academic year
  • Medicare
  • Individual Plans – Marketplace – Deductible MUST NOT be more than $2,500 for individual and/or family. In many cases even if an individual deductible is listed, the family deductible must be met before benefits apply and is considered the deductible. The Out-of-Pocket Max must not be more than $7,150. HSAC will verify individual plans quarterly.

Own Employer Group plans, short-term health insurance policies, traveler’s plans, or plans originating outside the United States will not be accepted as part of the Waiver process.

Acceptable coverage to waive the PNWU Sponsored Student Health Insurance Plan for all plans must include:

  • A provider network in the area of your PNWU location for primary care, specialty, hospital, and diagnostic care. Students must have comprehensive coverage in the states where the student has designated clinical coursework (HMO plans only qualify for the state in which you are residing).
  • Unlimited Major Medical Coverage
  • Unlimited Lifetime Benefits
  • Unlimited Office Visits
  • Coverage for an annual exam
  • Prescription coverage
  • Mental health coverage
  • Wellness Benefit – Preventive Care

State Medicaid

  • Didactic students who are permanent residents of Washington and remain in Washington the entire year are eligible to waive with their Washington State Medicaid. You must remain on location in Washington and have Medicaid coverage for the entire year.
  • Any other states’ Medicaid plans are NOT eligible to waive the PNWU student plan.
  • Third-year DO Students will be eligible to waive as a third-year student only (no Medicaid as a fourth-year) with Medicaid from the state of the regional site you are assigned to and if residency requirements for Medicaid are met. You must have active insurance coverage and submit your new waiver by the deadline of June 30. There are not late waiver exceptions or extensions to the deadline Because of most states’ requirements for Medicaid eligibility, students will need to secure other qualified health insurance to cover the gap between the end of Washington Medicaid coverage and the start of another state’s Medicaid coverage.
  • IMPORTANT: All students should note that Medicaid covers only life-threatening emergencies if the insured is outside the state where Medicaid coverage originates. If you anticipate spending any time outside the state where you hold Medicaid, you risk having no coverage should an illness or injury occur.

Clinical Rotations and Courses

Students are not eligible to waive with Medicaid Coverage or coverage with a limited network in clinical rotations/course. Students must have coverage that has comprehensive coverage throughout the United States. Clinical rotations/courses are defined as follows:

  • Doctor of Dental Medicine – second-, third-, and four-years
  • Doctor of Osteopathic Medicine – third- and fourth-year
  • Doctor of Physical Therapy – summer terms and spring term of third-year
  • Master of Science Occupational Therapy – summer terms

Coverage must be in force for the entire school term. Please note – you must have active coverage that meets all requirements set forth by PNWU by the waiver deadline. There are not exceptions to this policy or waiver deadline extensions.

For the 2024-2025 Academic Year, if an acceptable waiver is not received by the required waiver deadline, PNWU will finalize your enrollment in teh student health insurance plan. Your student account will automatically be assessed the applicable 2024-2025 Academic Year premium. You will no longer be eligible for a refund once your enrollment has been processed.

All full-time students are automatically assessed for half of the annual student health insurance premium upon registration for the Fall Semester. This fee is reversed only if you submit proof of health insurance coverage that meets the University’s coverage requirements by the designated deadline. When you fail to submit proof of alternative health insurance coverage by the deadline for your program/class year, your student health insurance plan enrollment is finalized. You are no longer eligible for a refund of the first half of the premium. You will automatically be assessed the second half of the premium upon registration for the spring term.

Periodic Waiver Verifications

HSAC will periodically verify health insurance plans approved during the waiver process to ensure students comply with the University’s health insurance coverage requirements.

If your waiver is approved, it is still subject to periodic verification throughout the academic year to ensure that your submitted plan is still active and meets the University’s health insurance coverage requirements. It is incumbent on the student to ensure their plan remains active and in compliance with the University’s health insurance requirements throughout the academic year, including summer and holidays.

If your plan is found to be inactive or out of compliance, the University reserves the right to enroll you in the student health insurance plan from the start of the period of non-compliance (even if your termination date was in the past) through the end of the current academic year. If your plan is found to be inactive or out of compliance, you will receive an email notification from HSAC, and you will have 14 calendar days to respond. If you do not respond within 14 calendar days, the University will proceed with enrollment in the student health insurance plan, assess your student account for the applicable premium charges, and notify your program of you non-compliance with the University’s health insurance requirements.

Involuntary Loss of Coverage/Age-Outs

If you originally waived out of the student health insurance plan but find that you need health insurance coverage later in the year due to an involuntary loss of coverage or if you have aged out of your parent’s insurance plan, you can also enroll via the HSAC’s PNWU portal. Students enrolling after the initial enrollment period due to an involuntary loss of coverage will be assessed a prorated portion of the insurance premium based on their enrollment dates. Students have 30 calendar days after an involuntary loss of coverage to enroll in the student health insurance plan or submit updated proof of coverage. Proof of coverage must hsow that the new coverage is in effect as of the termination date of previous coverage. No gaps in coverage are permitted.

  • Students must maintain continuous enrollment in health insurance. If you are submitting new proof of coverage, it must begin at the same time as yoru previous coverage termination. You are not eligible to waive if you have any coverage gap. IMPORTANT: Most state have residency requirement to be eligible to apply for Medicaid in that state. If you wish to change from Washington Medicaid to another state’s Medicaid plan, you will likely face a gap in coverage that could be several months. You will need to secure other qualified health insurance to avoid any coverage gap.

Once you have submitted the required information, you will receive an email indicating whether your waiver meets the PNWU requirements. If your coverage does not meet requirements, you will be provided with details in an email.

Please be aware that you will be automatically enrolled in the student health insurance plan, and the student health insurance charge will remain on your account if a waiver request is not completed and approved. PNWU will not accept waiver requests after your deadline.

Insurance Fraud Warning

Any person who knowingly presents a false or fraudulent claim for payment or a loss of benefits or knowingly presents false information in an insurance application is guilty of a crime and may be subject to fines and confinement in prison. 

Policy links: Student Health Care Coverage policy

Health Care Providers

The University does not endorse any specific health care provider, however for convenience, a list of providers has been made available as a resource on the Health Insurance webpage of PNWU.edu. Some providers or health care systems have agreed to prioritize PNWU students seeking primary care providers.

Students are expected to establish care with a primary care provider where they are located. Students should obtain healthcare from non-PNWU affiliated faculty members unless it is an emergency where they are the only provider option. Faculty members treating students for their healthcare needs are to recuse themselves from any discussions, or decisions involving the students’ academic or professional progress.

Learn more on the Health and Wellness webpages of PNWU.edu

Policy links: Student Physical Health Services policy

Wellness Spending Accounts

PNWU is committed to creating, promoting, and sustaining a culture of wellness that enables all PNWU students to achieve their desired state of health and well-being.

In an effort to encourage this culture of wellness, PNWU has created a Wellness Spending Account for PNWU students. The Wellness Spending Account is a personalized wellness health program that provides students with an allowance to support their engagement in wellness activities.

The Wellness Spending Accounts will be determined by the length of the program schedule for that year. Student Affairs will be responsible for managing these accounts. If you have any questions, please contact Student Affairs at studentaffairs@pnwu.edu.

Learn more on the Wellness Spending Account webpage of PNWU.edu.

Page revision date: June 18, 2024