STUDENT HEALTH PLAN 2020-2021 - NYU
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2020-2021
STUDENT HEALTH PLAN
TANDON SCHOOL OF
ENGINEERING
("the Policyholder")
Policy Number: WNY2021NYSHIP04
Group Number: ST0645SH
Effective: 8/21/2020 – 8/20/2021
Underwritten By: Provider Network: Administered By:
Wellfleet Group, LLC
Wellfleet New York Insurance
Co. ("the Company")
NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
WHAT’S INSIDE (Click on section header below to go to section in brochure.)
Student Health and Insurance at NYU ...........................................................................................................................3
Confidentiality ...............................................................................................................................................................3
Patient Protection and Affordable Care Act (PPACA) ....................................................................................................4
Student Health Insurance Plan Overview ......................................................................................................................4
Information for Graduate Employees NYU/UAW Local 2110 ........................................................................................5
Schedule of Benefits ......................................................................................................................................................5
Accidental Death and Dismemberment ..............................................................................................................22
Preauthorization Procedure ................................................................................................................................23
Student Health Insurance Plan Costs ...................................................................................................................23
Insurance Payment Options ................................................................................................................................24
Insurance Cards ...................................................................................................................................................24
Enrolling in the Student Health Insurance Plan ...........................................................................................................24
Eligibility...............................................................................................................................................................24
Automatic Enrollment .........................................................................................................................................25
Voluntary Enrollment ..........................................................................................................................................25
Dependents .........................................................................................................................................................25
How to Enroll .......................................................................................................................................................26
Enrollment Deadlines ..........................................................................................................................................26
Important Enrollment Rules for Matriculated Students ......................................................................................26
Fall 2020/Spring 2021 Automatic Enrollment Guide ...........................................................................................27
Special Enrollment Periods ..................................................................................................................................27
Waiving the Student Health Insurance Plan ................................................................................................................28
Waiver Criteria Applicable to All Students ..........................................................................................................28
How to Waive Online ...........................................................................................................................................29
Waiver Deadlines .................................................................................................................................................29
Important Waiver Rules .......................................................................................................................................29
International Students in F-1 or J-1 Visa Status ...........................................................................................................30
International Students Waiver Process ...............................................................................................................30
Information for Parents ...............................................................................................................................................31
Exclusions and Limitations ...........................................................................................................................................32
Claim Procedures .........................................................................................................................................................34
Grievances, Utilization Review, and Appeals...............................................................................................................34
Definitions ...................................................................................................................................................................35
Contact Information (pp. 41-42) ..................................................................................................................................41
Students Studying Away Insurance Program ...............................................................................................................43
Information for Graduate Employees NYU/UAW Local 2110 ......................................................................................43
Stu-Dent Dental Health Program .................................................................................................................................43
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
Student Health and Insurance at NYU
New York University values the health of its students and is committed to offering all students access to quality
healthcare and reasonably priced health insurance plans to help protect against financial hardships that may result
from high healthcare expenses.
While most undergraduate and graduate students are in good health and face few serious illnesses while in school,
medical and psychological issues can arise at any time, sometimes without warning. There are also certain health
concerns that may become apparent for the first time in early adulthood.
The high cost of healthcare in the United States presents a potentially serious financial risk to students. The absence
of adequate insurance coverage can result in temporary or permanent interruption of Your education; therefore,
NYU requires that all students registered in degree-granting programs maintain health insurance.
Most students are automatically enrolled in and charged Premium for the NYU sponsored student health insurance
plan (NYU sponsored plan) as part of the course registration process. Students who maintain alternate health
insurance coverage that meets the University’s minimum health insurance criteria may waive the NYU sponsored
student health insurance plan entirely (see Waiving the Student Health Insurance Plan section).
This brochure has been prepared to help You understand the benefits and levels of coverage the NYU sponsored
student health insurance plan offers.
Student Health Center Locations
Manhattan
726 Broadway, 2nd, 3rd, and 4th Floors
New York, NY 10003
(212) 443-1000
Brooklyn
6 MetroTech Center, ROG-B020
Brooklyn, NY 11201
(646) 997-3456
Confidentiality
Your privacy is Our priority. The Student Health Center (SHC) is legally and ethically obligated to protect the privacy
of a student’s health information.
Treatment of student health information is governed by the Family Educational Rights and Privacy Act (FERPA) and
the requirements of applicable New York State law. The SHC will only disclose this information in limited
circumstances in accordance with applicable law.
The SHC will not release medical information to anyone, including family, parents/legal guardians, NYU faculty/staff,
or outside agencies, without the written authorization of the student, except in emergency situations or to comply
with a subpoena or judicial order. In the case of a minor, the authorization of a parent or legal guardian is required
to release medical records. In a medical emergency, only relevant health information will be released to another
healthcare Provider.
The underwriter and administrator of the NYU-sponsored student health insurance plan also handle student health
information in connection with the operation of the plan. Treatment of such information is governed by the Health
Insurance Portability and Accountability Act (HIPAA) and the requirements of applicable New York State law.
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
Patient Protection and Affordable Care Act (PPACA)
The Affordable Care Act (ACA) was enacted to increase the availability of health insurance coverage to more
Americans. There are a multitude of medical coverage requirements and it is important for You to know that the
NYU sponsored student health insurance plan is fully ACA compliant.
Here’s additional information about the ACA to assist You in making coverage decisions:
Students are eligible to remain on a parent’s plan until age 26. However, You should compare the cost and benefits
of coverage under a parent’s plan to those of the NYU sponsored student health insurance plan.
Employer plans held by You or Your parents may be local HMO’s that are not appropriate for a student attending
school out of state.
The ACA created health insurance marketplaces for individuals to obtain coverage. However, You should carefully
review the terms of the coverage to compare with any other alternatives including in terms of: Deductibles,
Copayments, Coinsurance, and limited Provider networks. If You are interested in exploring this option, the web site
is www.healthcare.gov. You will be directed to the appropriate online marketplace for Your home state of residence.
Generally, international students holding an F-1 or J-1 visa are not eligible to purchase insurance through the
marketplaces because they must show permanent residency.
Student Health Insurance Plan Overview
Wellfleet Student Health Insurance Plan
The NYU sponsored student health insurance plan, administered by Wellfleet Group, LLC, is designed to provide
reasonably priced healthcare coverage. The insurance plan supplements the free services (as does any other health
insurance) provided at the SHC. The NYU sponsored student health insurance plan covers most medical treatments
and procedures provided at the SHC, for which there is a fee, as well as national coverage for medically necessary
healthcare services.
All matriculated students are eligible for enrollment in the Student Health Insurance Plan sponsored by NYU. See
Voluntary Enrollment section for more information about enrolling Dependents and other eligible enrollees.
The Insurance consists of the Tandon Student Health Insurance Plan designed to provide reasonably priced
healthcare coverage.
The plan offers coverage for services rendered by healthcare Providers who participate in the Cigna PPO network.
Visit www.wellfleetstudent.com/nyu to search for Cigna PPO Providers. Out-of-network Providers are also
covered but at a lower reimbursement level. (See Schedule of Benefits).
Please note: The SHC is an in-network Preferred Provider under the NYU sponsored student health insurance plan
underwritten by Wellfleet New York Insurance Company.
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
Information for Graduate Employees NYU/UAW Local 2110
Effective September 1, 2015, the University began providing its student health insurance plan (Basic Health Plan –
Individual Coverage) at 10% of the applicable premium rate to eligible graduate student employees. In addition,
eligible graduate student employees will be covered by the Stu-Dent Plan for NYU at no cost and will be automatically
enrolled in the Stu-Dent Plan upon confirmation of union eligibility.
For eligible Tandon graduate student employees, a Basic Health Plan insurance charge may initially appear on the
graduate student employee’s tuition bill, but will be adjusted when the student’s union eligibility is confirmed. At
that time the insurance charge on the Bursar account will be adjusted to 10% of the Basic Health Insurance Plan
charge for that term.
Dependent Coverage Premium Support Plan
Effective September 1, 2015, the University established a Graduate Employee Student Health Insurance Dependent
Premium Support Plan. For Academic Year 2019-2020, the Plan will be funded with $200,000, divided equally
between the fall and spring semesters.
Those eligible graduate employees who are doctoral candidates who actually purchase dependent coverage under
the Basic Student Health Insurance Plan and provide proof thereof, may, during the subject semester, apply for up
to 75% reimbursement of dependent coverage premiums. Actual reimbursement will depend on the number of
applications and the funds allocated for that semester. Unused funds, if any, will not carry over to a future semester.
The application deadline for reimbursement for fall 2019 is January 8, 2020 and for spring 2020 is August 20, 2020.
Schedule of Benefits
Availability of services at SHC locations varies, please verify location when making appointments.
For a more complete description of plan benefits, general terms and conditions, Preauthorization requirements, etc.,
please review the 2020-2021 Student Health Insurance Certificate at www.wellfleetstudent.com/nyu.
NYU TANDON SCHOOL OF ENGINEERING SCHEDULE OF BENEFITS
Metal Level: Platinum
NYU Tandon School of Engineering
Policy Number: WNY2021NYSHIP04
Group/Plan Number: ST0645SH
Policyholder Effective Date: August 21, 2020
Policyholder Termination Date: August 20, 2021
COST-SHARING Student Health Center Participating Provider Non-Participating
Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Medical
Deductible
• Individual $0 $0 $100
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
COST-SHARING Student Health Center Participating Provider Non-Participating
Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Out-of-Pocket Limit
• Individual $6,350 $6,350 $6,350
• Family $12,700 $12,700 $12,700
Accidental Death and See the Cost-Sharing
Dismemberment Expenses and Allowed
Benefits Amount section of this
$10,000 Certificate for a
Annual and Lifetime description of how We
Maximum. calculate the Allowed
Amount.
Any charges of a Non-
Participating Provider
that are in excess of
the Allowed Amount
do not apply towards
the Deductible or Out-
of-Pocket Limit. You
must pay the amount
of the Non-
Participating Provider’s
charge that exceeds
Our Allowed Amount.
OFFICE VISITS Student Health Center Participating Provider Non-Participating Limits
Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Primary Care Office Covered in full $20 Copayment 30% Coinsurance after See benefit for
Visits 0% Coinsurance Deductible description
(or Home Visits)
Specialist Office Visits Covered in full $20 Copayment 30% Coinsurance after See benefit for
(or Home Visits) 0% Coinsurance Deductible description
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PREVENTIVE CARE Student Health Center Participating Provider Non-Participating Limits
Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
• Well Child Visits Covered in full Covered in full 30% Coinsurance after See benefit for
and Deductible description
Immunizations*
• Adult Annual Covered in full Covered in full 30% Coinsurance after
Physical Deductible
Examinations*
• Adult Covered in full Covered in full 30% Coinsurance after
Immunizations* Deductible
• Routine Covered in full Covered in full 30% Coinsurance after
Gynecological Deductible
Services/Well
Woman Exams*
• Mammograms, Covered in full Covered in full 30% Coinsurance after
Screening and Deductible
Diagnostic
Imaging for the
Detection of
Breast Cancer
• Sterilization Covered in full Covered in full 30% Coinsurance after
Procedures for Deductible
Women*
• Vasectomy Covered in full $20 Copayment] 30% Coinsurance after
0% Coinsurance Deductible
• Bone Density Covered in full Covered in full 40% Coinsurance
Testing* after Deductible
• Screening for Covered in full Covered in full 30% Coinsurance after
Prostate Cancer Deductible
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PREVENTIVE CARE Student Health Center Participating Provider Non-Participating Limits
Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
• All other Covered in Full Covered in full 30% Coinsurance after
preventive Deductible
services required
by USPSTF and
HRSA.
*When preventive Use Cost-Sharing for Use Cost-Sharing for Use Cost-Sharing for
services are not appropriate service appropriate service appropriate service
provided in (Primary Care Office (Primary Care Office Visit (Primary Care Office
accordance with the Visit Specialist Office Specialist Office Visit Visit Specialist Office
comprehensive Visit Diagnostic Diagnostic Radiology Visit Diagnostic
guidelines supported Radiology Services Services Laboratory Radiology Services
by USPSTF and HRSA. Laboratory Procedures Procedures and Laboratory Procedures
and Diagnostic Testing) Diagnostic Testing) and Diagnostic Testing)
EMERGENCY CARE Student Health Center Participating Provider Non-Participating Limits
Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Pre-Hospital N/A Covered in full Covered in full See benefit for
Emergency Medical description
Services
(Ambulance Services)
Non-Emergency N/A Covered in full Covered in full See benefit for
Ambulance Services description
Emergency N/A $50 Copayment $50 Copayment See benefit for
Department 10% Coinsurance 10% Coinsurance not description
subject to Deductible
Copayment waived if Health care forensic Health care forensic
Hospital admission examinations examinations performed
performed under Public under Public Health Law
Health Law § 2805-I are § 2805-I are not subject
not subject to Cost- to Cost-Sharing
Sharing
Urgent Care Center N/A $20 Copayment 30% Coinsurance after See benefit for
0% Coinsurance Deductible description
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits
SERVICES and Member Responsibility Member Responsibility Provider Member
OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Advanced Imaging See benefit for
Services description
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
Specialist Office Deductible
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
Freestanding Deductible
Radiology Facility
• Performed as N/A 10% Coinsurance 40% Coinsurance after
Outpatient Deductible
Hospital Services
Preauthorization
Required
Allergy Testing and See benefit for
Treatment description
• Performed in a Covered in full $20 Copayment 30% Coinsurance after
PCP Office 0% Coinsurance Deductible
• Performed in a Covered in full $20 Copayment 30% Coinsurance after
Specialist Office 0% Coinsurance Deductible
Ambulatory Surgical N/A 10% Coinsurance 40% Coinsurance after See benefit for
Center Facility Fee Deductible description
Preauthorization
Required
Anesthesia Services N/A 10% Coinsurance 40% Coinsurance after See benefit for
(all settings) Deductible description
Autologous Blood N/A 10% Coinsurance 40% Coinsurance after See benefits
Banking Deductible for description
Cardiac and See benefits
Pulmonary for description
Rehabilitation
• Performed in a N/A 10% Coinsurance 30% Coinsurance after
Specialist Office Deductible
• Performed as N/A 10% Coinsurance 30% Coinsurance after
Outpatient Deductible
Hospital Services
• Performed as N/A Included as part of Included as part of
Inpatient Hospital inpatient Hospital service inpatient Hospital
Services Cost-Sharing service Cost-Sharing
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits
SERVICES and Member Responsibility Member Responsibility Provider Member
OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Chemotherapy See benefit for
description
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
PCP Office Deductible
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
Specialist Office Deductible
• Performed as N/A 10% Coinsurance 40% Coinsurance after
Outpatient Deductible
Hospital Services
Preauthorization
Required
Chiropractic Services N/A $20 Copayment 30% Coinsurance after See benefit for
0% Coinsurance Deductible description
Preauthorization
Required
Clinical Trials Use Cost-Sharing for Use Cost-Sharing for Use Cost-Sharing for See benefit for
appropriate service appropriate service appropriate service description
Diagnostic Testing See benefit for
description
• Performed in a 10% Coinsurance 10% Coinsurance 40% Coinsurance after
PCP Office Deductible
• Performed in a 10% Coinsurance 10% Coinsurance 40% Coinsurance after
Specialist Office Deductible
• Performed as N/A 10% Coinsurance 40% Coinsurance after
Outpatient Deductible
Hospital Services
Dialysis See benefit for
description
• Performed in a N/A $20 Copayment 30% Coinsurance after
PCP Office 0% Coinsurance Deductible
• Performed in a N/A $20 Copayment 30% Coinsurance after
Specialist Office 0% Coinsurance Deductible
• Performed in a N/A $20 Copayment 30% Coinsurance after
Freestanding 0% Coinsurance Deductible
Center
• Performed as N/A 10% Coinsurance 40% Coinsurance after
Outpatient Deductible
Hospital Services
• Performed at N/A 10% Coinsurance 40% Coinsurance after
Home Deductible
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits
SERVICES and Member Responsibility Member Responsibility Provider Member
OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Habilitation Services 10% Coinsurance 10% Coinsurance 40% Coinsurance after 60 visits per
(Physical Therapy, Deductible condition, per
Occupational Therapy Plan Year
or Speech Therapy) combined
therapies
Home Health Care N/A 10% Coinsurance 40% Coinsurance after 40 visits per
Deductible Plan Year
Preauthorization
Required
Infertility Services Use Cost-Sharing for Use Cost-Sharing for Use Cost-Sharing for See benefit for
appropriate service appropriate service appropriate service description
(Office Visit Diagnostic (Office Visit Diagnostic (Office Visit Diagnostic
Radiology Services Radiology Services Radiology Services
Surgery Laboratory & Surgery Laboratory & Surgery Laboratory &
Diagnostic Procedures) Diagnostic Procedures) Diagnostic Procedures)
Infusion Therapy See benefit for
description
• Performed in a Covered in full $20 Copayment 30% Coinsurance after
PCP Office 0% Coinsurance Deductible
• Performed in Covered in full $20 Copayment 30% Coinsurance after
Specialist Office 0% Coinsurance Deductible
• Performed as N/A 10% Coinsurance 40% Coinsurance after
Outpatient Deductible
Hospital Services
• Home Infusion N/A 10% Coinsurance 40% Coinsurance after Home infusion
Therapy Deductible counts toward
home health
care visit limits
Inpatient Medical N/A 10% Coinsurance 40% Coinsurance after See benefit for
Visits Deductible description
Interruption of
Pregnancy
• Medically N/A Covered in full 40% Coinsurance after Unlimited
Necessary Deductible
Abortions
• Elective Abortions N/A 10% Coinsurance 40% Coinsurance after One (1)
Deductible procedure per
Plan Year
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits
SERVICES and Member Responsibility Member Responsibility Provider Member
OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Laboratory See benefit for
Procedures description
• Performed in a 10% Coinsurance 10% Coinsurance 40% Coinsurance after
PCP Office Deductible
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
Specialist Office Deductible
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
Freestanding Deductible
Laboratory Facility
• Performed as N/A 10% Coinsurance 40% Coinsurance after
Outpatient Deductible
Hospital Services
Maternity and See benefit for
Newborn Care description
• Prenatal Care N/A Covered in full 30% Coinsurance after
provided in Deductible
accordance with
the comprehensive
guidelines
supported by
USPSTF and HRSA
• Prenatal Care that Use Cost-Sharing for Use Cost-Sharing for Use Cost-Sharing for
is not provided in appropriate service appropriate service appropriate service
accordance with (Primary Care Office (Primary Care Office (Primary Care Office
the comprehensive Visit, Specialist Office Visit, Specialist Office Visit, Specialist Office
guidelines Visit, Diagnostic Visit, Diagnostic Visit, Diagnostic
supported by Radiology Services, Radiology Services, Radiology Services,
USPSTF and HRSA Laboratory Procedures Laboratory Procedures Laboratory Procedures
and Diagnostic Testing) and Diagnostic Testing) and Diagnostic Testing)
• Inpatient Hospital N/A 10% Coinsurance 40% Coinsurance after
Services and Deductible One (1) home
Birthing Center care visit is
covered at no
• Physician and N/A 10% Coinsurance 40% Coinsurance after Cost-Sharing if
Midwife Services Deductible mother is
for Delivery discharged
from Hospital
early
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits
SERVICES and Member Responsibility Member Responsibility Provider Member
OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Maternity and Maternity and
Newborn Care Newborn Care
(continued) (continued)
• Breastfeeding N/A Covered in full 30% Coinsurance after Covered for
Support, Deductible duration of
Counseling and breast feeding
Supplies, Including
Breast Pumps
• Postnatal Care N/A $20 Copayment 30% Coinsurance after
0% Coinsurance Deductible
Preauthorization
Required
Outpatient Hospital N/A 10% Coinsurance 40% Coinsurance after See benefit for
Surgery Facility Deductible description
Charge
Preauthorization
Required
Preadmission Testing N/A 10% Coinsurance 40% Coinsurance after See benefit for
Deductible description
Prescription Drugs See benefit for
Administered in Office description
or Outpatient
Facilities
• Performed in a Covered in full Covered in full 30% Coinsurance after
PCP Office Deductible
• Performed in Covered in full Covered in full 30% Coinsurance after
Specialist Office Deductible
• Performed in N/A 10% Coinsurance 40% Coinsurance after
Outpatient Deductible
Facilities
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits
SERVICES and Member Responsibility Member Responsibility Provider Member
OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Diagnostic Radiology See benefit for
Services description
• Performed in a 10% Coinsurance 10% Coinsurance 40% Coinsurance after
PCP Office Deductible
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
Specialist Office Deductible
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
Freestanding Deductible
Radiology Facility
• Performed as N/A 10% Coinsurance 40% Coinsurance after
Outpatient Deductible
Hospital Services
Preauthorization
Required
Therapeutic Radiology See benefit for
Services description
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
Specialist Office Deductible
• Performed in a N/A 10% Coinsurance 40% Coinsurance after
Freestanding Deductible
Radiology Facility
• Performed as N/A 10% Coinsurance 40% Coinsurance after
Outpatient Deductible
Hospital Services
Preauthorization
Required
Rehabilitation 10% Coinsurance 10% Coinsurance 40% Coinsurance after 60 visits per
Services (Physical Deductible condition, per
Therapy, Occupational Plan Year
Therapy or Speech combined
Therapy) therapies
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PROFESSIONAL Student Health Center Participating Provider Non-Participating Limits
SERVICES and Member Responsibility Member Responsibility Provider Member
OUTPATIENT CARE for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Second Opinions on Covered in full $20 Copayment 30% Coinsurance after See benefit for
the Diagnosis of 0% Coinsurance Deductible description
Cancer,
Surgery and Other Second opinions on
diagnosis of cancer are
Covered at
participating Cost-
Sharing for non-
participating Specialist
when a Referral is
obtained.
Surgical Services See benefit for
(including Oral description
Surgery
Reconstructive Breast
Surgery Other
Reconstructive and
Corrective Surgery;
and Transplants
• Inpatient Hospital N/A 10% Coinsurance 40% Coinsurance after
Surgery Deductible
• Outpatient N/A 10% Coinsurance 40% Coinsurance after
Hospital Surgery Deductible
• Surgery N/A 10% Coinsurance 40% Coinsurance after
Performed at an Deductible
Ambulatory
Surgical Center
• Office Surgery 10% Coinsurance 10% Coinsurance 40% Coinsurance after
Deductible
Preauthorization
Required
ADDITIONAL Student Health Center Participating Provider Non-Participating Limits
SERVICES, Member Responsibility Member Responsibility Provider Member
EQUIPMENT and for Cost-Sharing for Cost-Sharing Responsibility for
DEVICES Cost-Sharing
ABA Treatment for Covered in full $20 Copayment 30% Coinsurance after See benefit
Autism Spectrum 0% Coinsurance Deductible description
Disorder
Assistive Covered in full $20 Copayment 30% Coinsurance after See benefit for
Communication 0% Coinsurance Deductible description
Devices for Autism
Spectrum Disorder
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
ADDITIONAL Student Health Center Participating Provider Non-Participating Limits
SERVICES, Member Responsibility Member Responsibility Provider Member
EQUIPMENT and for Cost-Sharing for Cost-Sharing Responsibility for
DEVICES Cost-Sharing
Diabetic Equipment, See benefit for
Supplies and Self- description
Management
Education See
Prescription
Diabetic Equipment, See the Prescription See the Prescription See the Prescription Drug benefit
Supplies and Insulin Drug Cost-Sharing Drug Cost-Sharing Drug Cost-Sharing
(up to a 90 day
supply)
• Diabetic Covered in full $20 Copayment 30% Coinsurance after
Education 0% Coinsurance Deductible
Durable Medical 10% Coinsurance 10% Coinsurance 40% Coinsurance after See benefit for
Equipment and Braces Deductible description
External Hearing Aids N/A 10% Coinsurance 40% Coinsurance after Single
Deductible purchase once
every 3 years
Cochlear Implants N/A 10% Coinsurance 40% Coinsurance after One per ear
Deductible per time
Preauthorization Covered
Required
Hospice Care
• Inpatient N/A 10% Coinsurance 40% Coinsurance after 210 days per
Deductible Plan Year
• Outpatient N/A 10% Coinsurance 40% Coinsurance after Five (5) visits
Deductible for family
bereavement
counseling
Medical Supplies 10% Coinsurance 10% Coinsurance 40% Coinsurance after See benefit for
Deductible description
Prosthetic Devices
• External 10% Coinsurance 10% Coinsurance 40% Coinsurance after One (1)
Deductible prosthetic
device, per
limb, per
lifetime
• Internal N/A 10% Coinsurance 40% Coinsurance after Unlimited
Deductible
See benefit for
description
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
INPATIENT SERVICES Student Health Center Participating Provider Non-Participating Limits
and FACILITIES Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Inpatient Hospital for N/A 10% Coinsurance 40% Coinsurance after See benefit for
a Continuous Deductible description
Confinement
(including an Inpatient
Stay for Mastectomy
Care, Cardiac and
Pulmonary
Rehabilitation, and
End of Life Care)
Preauthorization
Required. However,
Preauthorization is
not required for
emergency
admissions or
services provided in a
neonatal intensive
care unit of a Hospital
certified pursuant to
Article 28 of the
Public Health Law.
Observation Stay N/A 10% Coinsurance 40% Coinsurance after See benefit for
Deductible description
Skilled Nursing Facility N/A 10% Coinsurance 40% Coinsurance after 200 days per
(including Cardiac and Deductible Plan Year
Pulmonary
Rehabilitation) See benefit for
description
Preauthorization
Required
Inpatient Habilitation N/A 10% Coinsurance 40% Coinsurance after Unlimited days
Services (Physical Deductible
Speech and See benefit for
Occupational description
Therapy)
Preauthorization
Required
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
INPATIENT SERVICES Student Health Center Participating Provider Non-Participating Limits
and FACILITIES Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Inpatient N/A 10% Coinsurance 40% Coinsurance after Unlimited days
Rehabilitation Deductible
Services (Physical See benefit for
Speech and description
Occupational
Therapy)
Preauthorization
Required
MENTAL HEALTH and Student Health Center Participating Provider Non-Participating Limits
SUBSTANCE USE Member Responsibility Member Responsibility Provider Member
DISORDER SERVICES for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Inpatient Mental N/A 10% Coinsurance 40% Coinsurance after See benefit for
Health Care for a Deductible description
continuous
confinement when in
a Hospital
(including Residential
Treatment)
Preauthorization
Required. However,
Preauthorization is
not required for
emergency
admissions or for
admissions at
Participating OMH-
licensed Facilities for
Members under 18.
Outpatient Mental Covered in full $20 Copayment 30% Coinsurance after See benefit for
Health Care 0% Coinsurance Deductible description
(including Partial
Hospitalization and
Intensive Outpatient
Program Services)
Except for Office
Visits,
Preauthorization
Required
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
MENTAL HEALTH and Student Health Center Participating Provider Non-Participating Limits
SUBSTANCE USE Member Responsibility Member Responsibility Provider Member
DISORDER SERVICES for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Inpatient Substance N/A 10% Coinsurance 40% Coinsurance after See benefit for
Use Services Deductible description
for a continuous
confinement when in
a Hospital
(including Residential
Treatment)
Preauthorization
Required. However,
Preauthorization is
Not Required for
Emergency
Admissions or for
Participating OASAS-
certified Facilities.
Outpatient Substance N/A $20 Copayment 30% Coinsurance after Up to 20 visits
Use Services 0% Coinsurance Deductible per Plan Year
(including Partial may be used
Hospitalization, for family
Intensive Outpatient counseling
Program Services, and
Medication Assisted See benefit for
Treatment) description
Except for Office
Visits,
Preauthorization
Required.
However,
Preauthorization is
not required for
Participating OASAS-
certified Facilities.
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
PRESCRIPTION DRUGS Student Health Center Participating Provider Non-Participating Limits
Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
You may request a copy of the Wellfleet Rx/KPP Formulary. The Formulary is also available on the Wellfleet Rx website
at www.WellfleetRx.com. You may inquire if a specific drug is Covered under the Certificate by contacting Wellfleet
Student at the number on Your ID card, (877) 373-1170.
*Certain Prescription Drugs are not subject to Cost-Sharing when provided in accordance with the comprehensive
guidelines supported by HRSA or if the item or service has an “A” or “B” rating from the USPSTF
Retail Pharmacy
Supply Limits. Except for contraceptive drugs, devices, or products, We will pay for no more than a 30-day supply of a
Prescription Drug purchased at a retail pharmacy. You are responsible for one (1) Cost-Sharing amount for up to a 30-
day supply.
You may have the entire supply (of up to 12 months) of the contraceptive drug, device, or product dispensed at the
same time. Contraceptive drugs, devices, or products are not subject to Cost-Sharing when provided by a Participating
Pharmacy.
Please refer to Certificate of coverage for details.
30-day supply See benefit for
description
Tier 1 $10 Copayment $10 Copayment $10 Copayment
0% Coinsurance 0% Coinsurance 0% Coinsurance not
subject to Deductible
Tier 2 $25 Copayment $25 Copayment $25 Copayment
0% Coinsurance 0% Coinsurance 0% Coinsurance not
If You have an subject to Deductible
Emergency Condition,
Preauthorization is
not required for a five
(5) day emergency
supply of a Covered
Prescription Drug
used to treat a
substance use
disorder, including a
Prescription Drug to
manage opioid
withdrawal and/or
stabilization and for
opioid overdose
reversal.
Enteral Formulas See benefit for
Tier 1 $10 Copayment $10 Copayment $10 Copayment description
0% Coinsurance 0% Coinsurance 0% Coinsurance not
subject to Deductible
Tier 2 $25 Copayment $25 Copayment $25 Copayment
0% Coinsurance 0% Coinsurance 0% Coinsurance not
subject to Deductible
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
WELLNESS BENEFITS Student Health Center Participating Provider Non-Participating
Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Gym Reimbursement N/A Up to $200 per six (6) Up to $200 per six (6) See Benefit
month period; up to an month period; up to an description
additional $100 per six additional $100 per six
(6) month period for (6) month period for
Covered Dependents Covered Dependents
DENTAL and VISION Student Health Center Participating Provider Non-Participating Limits
CARE Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Pediatric Dental Care
• Preventive Dental N/A $40 Copayment 40% Coinsurance after
Care 20% Coinsurance Deductible One (1) dental
exam and
• Routine Dental N/A $40 Copayment 40% Coinsurance after cleaning per six
Care 20% Coinsurance Deductible (6)-month
period
• Major Dental N/A $40 Copayment 40% Coinsurance after
(Endodontics, 20% Coinsurance Deductible
Periodontics, Oral
Surgery and Full mouth x-
Prosthodontics) rays or
panoramic x-
• Orthodontics N/A $40 Copayment 40% Coinsurance after rays at 36
20% Coinsurance Deductible month
Orthodontics and intervals and
Major Dental Require bitewing x-rays
Preauthorization at six (6)
month
intervals
Pediatric Vision Care
• Exams Covered in full $30 Copayment 40% Coinsurance after One (1) exam
20% Coinsurance Deductible per Plan Year
• Lenses and $30 Copayment $50 Copayment 40% Coinsurance after One (1)
Frames 20% Coinsurance 20% Coinsurance Deductible prescribed
lenses and
• Contact Lenses $30 Copayment $50 Copayment 40% Coinsurance after frames per
20% Coinsurance 20% Coinsurance Deductible Plan Year
Contact Lenses
Require
Preauthorization
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
DENTAL and VISION Student Health Center Participating Provider Non-Participating Limits
CARE Member Responsibility Member Responsibility Provider Member
for Cost-Sharing for Cost-Sharing Responsibility for
Cost-Sharing
Adult Vision Care
• Exams Covered in full $30 Copayment 40% Coinsurance after One (1) exam
20% Coinsurance Deductible per Plan Year
Contact Lenses
Require
Preauthorization
Emergency Medical 0% coinsurance of - Actual Cost Unlimited
Evacuation Annual Limits
Combined with
Repatriation
Benefit.
Repatriation of 0% coinsurance of - Actual Cost Unlimited
Remains Annual Limits
Combined with
Medical
Evacuation
Benefit.
Accidental Death and N/A N/A N/A $10,000
Dismemberment Annual and
Benefits Lifetime
Maximum
Accidental Death and Dismemberment
If, as the result of a covered Accident, You sustain any of the following losses, We will pay the benefit shown. The
loss must occur within 365 days of the Accident.
Percentage of Maximum Amount
Loss of Life ........................................................................................................100%
Loss of hand ....................................................................................................... 50%
Loss of Foot ....................................................................................................... 50%
Loss of either one hand, one foot or sight of one eye ....................................... 50%
Loss of more than one of the above losses due to one Accident......................100%
Accident means a sudden, unforeseeable external event which directly and from no other cause, results in loss of
life, hand, foot or sight.
Loss of hand or foot means the complete severance through or above the wrist or ankle joint. Loss of eye means
the total permanent loss of sight in the eye. The maximum amount is the largest amount payable under this benefit
for all losses resulting from any one Accident.
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
Preauthorization Procedure
Preauthorization is required before You receive certain Covered Services. You are responsible for requesting
Preauthorization for the in-network and out-of-network services listed in the Schedule of Benefits section of the
Certificate.
If You seek coverage for services that require Preauthorization, You must call Wellfleet Student at the number
indicated on Your NYU sponsored Tandon student health insurance ID card.
You must contact Wellfleet Student to request Preauthorization as follows:
• At least two (2) weeks prior to a planned admission or surgery when Your Provider recommends inpatient
Hospitalization. If that is not possible, then as soon as reasonably possible during regular business hours
prior to the admission.
• At least two (2) weeks prior to ambulatory surgery or any ambulatory care procedure when Your Provider
recommends the surgery or procedure be performed in an ambulatory surgical unit of a Hospital or in an
Ambulatory Surgical Center. If that is not possible, then as soon as reasonably possible during regular
business hours prior to the surgery or procedure.
You must contact Wellfleet Student to provide notification as follows:
• If You are hospitalized in cases of an Emergency Condition, You must call Wellfleet Student within 48 hours
after Your admission or as soon thereafter as reasonably possible.
After receiving a request for approval, Wellfleet Student will review the reasons for Your planned treatment and
determine if benefits are available. Criteria will be based on multiple sources which may include medical policy,
clinical guidelines, and pharmacy and therapeutic guidelines.
Student Health Insurance Plan Costs
Costs for Students
Coverage Period Cost
Annual 8/21/20 – 8/20/21 $1,964
--------------------------------------------------------------------------------------------------------------------------------------------------------
Fall Term 8/21/20 – 1/8/21 $759
--------------------------------------------------------------------------------------------------------------------------------------------------------
Spring/Summer Term 1/9/21 – 8/20/21 $1,205
--------------------------------------------------------------------------------------------------------------------------------------------------------
Summer Term 5/14/21 – 8/20/21 $533
-------------------------------------------------------------------------------------------------
-------------------------------------------------------
Costs for Dependent Coverage (Spouse/Domestic Partner/One or More Children)
Coverage Period Cost
Annual 8/21/20 – 8/20/21 $1,964
--------------------------------------------------------------------------------------------------------------------------------------------------------
Fall Term 8/21/20 – 1/8/21 $759
--------------------------------------------------------------------------------------------------------------------------------------------------------
Spring/Summer Term 1/9/21 – 8/20/21 $1,205
--------------------------------------------------------------------------------------------------------------------------------------------------------
Summer Term 5/14/21 – 8/20/21 $533
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
Costs for Family Coverage (Student/Spouse/Domestic Partner/One or More Children)
Coverage Period Cost
Annual 8/21/20 – 8/20/21 $1,964
--------------------------------------------------------------------------------------------------------------------------------------------------------
Fall Term 8/21/20 – 1/8/21 $759
--------------------------------------------------------------------------------------------------------------------------------------------------------
Spring/Summer Term 1/9/21 – 8/20/21 $1,205
--------------------------------------------------------------------------------------------------------------------------------------------------------
Summer Term 5/14/21 – 8/20/21 $533
Insurance Payment Options
The NYU sponsored student health insurance plan is an annual policy for students enrolled in NYU sponsored plan.
Students may choose from the following payment options:
A. ANNUAL PAYMENT IN FULL at the time of fall registration, with no insurance charge at spring registration.
• Student’s coverage will continue through August 20th, even if they are not registered for spring classes.
(However, they will not have access to services at the SHC after January 8th for January graduates and after
graduation for May graduates.)
• Students cannot get a partial refund of the spring/summer portion of the annual insurance charge after the
September 30th enrollment deadline.
B. TWO INSTALLMENT PAYMENT PLAN (default plan): The first payment is due at the time of fall registration and
the second at spring registration. The spring insurance charge is higher than the fall charge because it includes
payment for coverage over the summer months.
• Students will be automatically enrolled in the plan and billed the spring/ summer health insurance charge
if, and only if, they are registered for classes or maintaining matriculation for the spring semester.
• Students who are not registered for classes or maintaining matriculation for the spring semester will have
their insurance coverage end on January 8th.
Insurance Cards
Insurance ID Cards are available to each student in a variety of ways:
• An online insurance card can be obtained by going to the Wellfleet Student web site
(www.wellfleetstudent.com/nyu). Click the link for “Online ID Card.”
• An email will be sent on September 1, 2020 to those students enrolled in the NYU sponsored student health
insurance plan with instructions on how to obtain their electronic ID cards.
We encourage You to carry Your NYU ID and insurance card at all times.
Enrolling in the Student Health Insurance Plan
Eligibility
Students are eligible to enroll in the NYU sponsored student health insurance plan if they are:
• registered for one or more credits in a degree-granting program at NYU
• maintaining matriculation (completing certain academic programs and not enrolled in classes)
• Students with F-1 or J-1 visa status
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
• post-doctoral research trainees/fellows, paid by NYU on stipends (code 542) or paid directly by external
sponsors
• Dependents of an insured Students (Spouse/domestic partner and Children up until the end of the month
in which the Child turns age 26)
Automatic Enrollment
Most students are automatically enrolled in and charged Premium for the NYU sponsored student health plan as
part of the course registration process. Students should see the Automatic Enrollment Guide to determine if they
will be automatically enrolled.
Students who maintain alternate health insurance coverage that meets the University’s minimum health insurance
criteria may apply to waive the Student Health Insurance Plan entirely (see Waiving the Student Health Insurance
Plan section).
Please note: Adding or dropping courses during the registration period may affect a student’s automatic enrollment
in the NYU sponsored student health insurance plan. In such situations, confirm Your enrollment status before the
appropriate semester deadline (see Enrollment Deadlines section) to ensure Your coverage.
For students eligible for Graduate Employee NYU/UAW Local 2110, please see Graduate Employee NYU/UAW Local
2110 section.
Voluntary Enrollment
Students registered for classes or maintaining matriculation but not automatically enrolled, have the option to enroll
in the NYU sponsored student health insurance plan before the appropriate semester deadline (see Enrollment
Deadlines section) by completing the online enrollment process at www.nyu.edu/health/insurance (See Automatic
Enrollment Guide).
If You are on a school sanctioned leave: click here for NYU's policy.
Dependents
Eligibility
Eligible Dependents are:
a) the covered Student’s Spouse or domestic partner; and/or
b) the covered Student’s Child under the age of 26 years.
How to Enroll
To enroll eligible Dependents, insured Students must complete the online enrollment application and make payment
at www.wellfleetstudent.com/nyu by clicking on the Dependent Enrollment link from the menu on the left side of
the webpage by the appropriate deadline (see Enrollment Deadlines section). Dependent enrollment will be
available from 8/1 - 9/30.
Payment Options (Please see Costs section for costs.)
Students enrolling Dependents in the NYU sponsored student health insurance plan before the September 30th fall
term deadline may choose an annual payment option or an installment payment option. For students choosing the
installment payment option:
• The fall payment is due at the time of the fall enrollment.
• The spring payment is due by January 8th for the Dependent coverage to continue until August 20, 2021
(the end of the Plan Year). Students will receive a 30-day notice before their fall coverage ends with a
request for payment for the spring term coverage.
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Wellfleet Student PO Box 15369 Springfield, MA 01115-5369NEW YORK UNIVERSITY • TANDON SCHOOL OF ENGINEERING • 2020 - 2021 STUDENT HEALTH INSURANCE PLAN
Effective Dates of Coverage
Annual 2020-2021 August 21, 2020 - August 20, 2021
Fall 2020 August 21, 2020 - January 8, 2021
Spring/Summer 2021 January 9, 2021 - August 20, 2021
Summer 2021 May 14, 2021- August 20, 2021
How to Enroll
Students should evaluate their options by reviewing the benefits and exclusions of the NYU sponsored student health
insurance plan. Students should have their student ID number (shown on the admissions letter or on the back of the
NYU ID card) handy before accessing the online system during the enrollment periods.
• Go to www.nyu.edu/health/insurance
• Click on the box that indicates, “Enroll in or Waive out.” Read the general information and follow the
instructions for enrolling.
• At the end of the process, You must confirm Your enrollment selection in order for Your request to be
processed.
• Print the Confirmation of Status letter. A confirmation will also be sent to the e-mail address provided.
Enrollment Deadlines
If Your first semester of The online enrollment The SEMESTER DEADLINE for
the academic year is: system becomes available: enrolling in the NYU Plans is:
Fall 2020 June 16 September 30
--------------------------------------------------------------------------------------------------------------------------------------------------------
Spring 2021 November 3 February 10
--------------------------------------------------------------------------------------------------------------------------------------------------------
Summer 2021 April 6 June 5
--------------------------------------------------------------------------------------------------------------------------------------------------------
Important Enrollment Rules for Matriculated Students
• If the online enrollment process is not completed by the deadline, the plan in which the student is
automatically enrolled will be in effect for all or any remaining part of the academic year.
• Students who were only billed the fall semester health insurance charge at the time of fall registration:
o will be automatically enrolled in the plan and billed the spring/summer health insurance charge if,
and only if, they are registered for classes or maintaining matriculation for the spring semester.
o will have their insurance coverage end on January 8th if they are not registered for classes or
maintaining matriculation for the spring semester.
• Students who paid the annual health insurance charge at the time of fall registration:
o will continue coverage through August 20th, even if they are not registered or matriculated for
spring classes. (However, they will not have access to services at the SHC after January 8th for
January graduates and after graduation for May graduates.)
o cannot get a partial refund of the spring/summer portion of the annual insurance charge after the
September 30th enrollment deadline.
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