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FAQs

The additional information provided in the Student Injury and Sickness Insurance Plan  Frequently Asked Questions  (SISIP FAQs) is meant to assist you in your decision making about health insurance coverage, but is not offered as nor should it be construed as or relied upon as legal advice or complete and comprehensive information about your current policy, available coverage or health insurance law.  For additional information, including information about the health care law, finding insurance options, and accessing the health insurance marketplace, please refer to Healthcare.gov.  Please refer to your insurance plan details and contact your insurance company if you need clarification regarding coverage.  If you have SISIP, the contact number for UnitedHealthcare Customer Service is 1-800-505-4160.

Question: Can I opt out/waive and then later enroll in SISIP?

Answer:  If you opt out/waive, then you can only be eligible to enroll in SISIP if you have a life status change.  If you are eligible to enroll in SISIP due to a life status change, the start date of your coverage would be the date you activate your coverage.  Retroactive coverage is not available. The plan cost will be pro-rated.  Students who waive coverage can only request to enroll in the event of a life status change in which they involuntarily lose coverage under their original plan (examples: marriage, divorce, loss of job, etc.). To be eligible again, you must submit an enrollment form, provide proof of involuntary loss of insurance, and provide payment in full within 30 days of losing coverage.  After 30 days, you will no longer be eligible to enroll until the following academic year.   Please contact Student Accounts in Green Hall, Room 119 at (609)771-2172 or stuaccts@tcnj.edu for additional information.

Question: If I want to opt out/waive and decide not to participate in SISIP for Academic Year 2017-2018, what are my options?

Answer:  To be able to opt out of the First Risk/UnitedHealthcare plan, as a full-time student you must provide evidence of health insurance coverage and waive on the UnitedHealthcare website by the opt-out deadline.

All students should be reminded that the Federal Government still requires that all citizens be covered by a PPACA compliant plan or they will be subject to tax liabilities beginning January 2014.  Students are encouraged to review their insurance options prior to waiving or enrolling in the plan offered through The College.

If you are in need of health insurance coverage and you choose not to participate in the new plan, other options may be available to you.  As of the date of this email, the Federal Government still maintains health insurance exchanges that allow families and individuals in need of health insurance coverage to compare coverage and pricing from a variety of different insurance companies offering plans in your area. The PPACA also required employer plans to continue to provide dependent coverage to their employee’s dependents up to age 26.  Additionally the PPACA expanded Medicaid eligibility in many States including NJ.  To determine if you might be eligible for the expanded Medicaid coverage, you will also need to apply through your state healthcare exchange.  For additional information, including information about the health care law, finding insurance options, and accessing your state’s health insurance exchange, please refer to http://www.healthcare.gov.  As you may be aware, this issue is currently under review by the Federal Government and it is not clear if the PPACA will continue or be repealed, so the aforementioned information is subject to change.

For students who were previously covered only by the expiring plan with UnitedHealthcare, that do not have access to any other insurance, that do not wish to participate in the plan being offered through The College, and that need health insurance in order to waive the upcoming plan, they will need to call UnitedHealthcare at 1-800-505-4160. They will provide you with appropriate documentation to assist you with the enrollment process through the exchanges.  While the open enrollment period for the exchanges for 2017 is closed, you may be eligible for a special enrollment due to a life change given the expiring policy with UnitedHealthcare expires June 29, 2017 and policy coverage is being terminated.     Assuming that there are not changes made by the Federal Government, coverage available through the exchanges will, if purchased, provide health insurance through December 31, 2017.  Beginning November 1, 2017, the open enrollment period for the 2018 health insurance policy will begin and you will need to participate if you wish to continue your coverage for 2018.

Question: I am a part-time student and I was told that I am not eligible to participate in SISIP for Academic Year 2017-2018. What are my options to obtain health insurance coverage?

Answer: All students should be reminded that the Federal Government still requires that all citizens be covered by a PPACA compliant plan or they may be subject to tax liabilities beginning January 2014.

If you are in need of health insurance coverage and as a part-time student are not eligible for the new plan offered through the college, other options may be available to you.  The Federal Government has established health insurance exchanges that allow families and individuals in need of health insurance coverage to compare coverage and pricing from a variety of different insurance companies offering plans in your area. The PPACA also required employer plans to continue to provide dependent coverage to their employee’s dependents up to age 26.  Additionally the PPACA expanded Medicaid eligibility in many States including NJ.  To determine if you might be eligible for the expanded Medicaid coverage, you will also need to apply through your state healthcare exchange.  For additional information, including information about the health care law, finding insurance options, and accessing your state’s health insurance exchange, please refer to http://www.healthcare.gov.

For students who were previously full-time students and covered only by the expiring plan with United Healthcare, that do not have access to any other insurance, that cannot participate in the upcoming plan offered through the college, and that need health insurance, they will need to call UnitedHealthcare at 1-800-505-4160. They will provide you with appropriate documentation to assist you with the enrollment process through the exchanges.  While the open enrollment period for the exchanges may be closed, you may be eligible for a special enrollment due to a life change given the expiring policy with UnitedHealthcare expires June 29, 2017 and policy coverage is being terminated.

Question:  If I use SISIP prior to receiving my student bill, am I still able to opt out?

Answer:  No. You cannot opt out after using the policy.   Use of the policy indicates acceptance of coverage and the requirement to pay the premium.

Question:  If I am covered by my parent’s insurance plan, why would I need SISIP?

Answer:  We find that most students do not understand how their health insurance and prescription coverage works or what it covers.   In some cases, where students do have insurance on their own or through parent/guardian plans, the coverage may not be sufficient or may carry higher co-pays and deductibles, have different coverage in certain instances, or carry higher premiums than the plan offered through the College.  Every student should review any coverage that they have or that is being offered and determine if their insurance is appropriate for them.  Some students will not see a health care provider for a health problem because the use of their parents’ insurance will compromise confidentiality. These issues complicate and delay health care needed at college.

Question:  I am covered by my parent’s health insurance plan.  I am interested though in keeping SISIP as a supplement to my existing insurance plan.  Which plan would be considered “primary”?

Answer:  You must be certain to abide by all terms and conditions of any insurance you have.  In many cases, as the insurance coverage through the First Risk/UnitedHealthcare plan is an individual policy and coverage under a parent/guardian plan is as a dependent, SISIP is often deemed as primary.  Refer to your insurance details under Coordination of Benefits for additional information.  The College is not able to make this determination for you.

Question:  Let’s say I am on campus, am sick and need to see someone.  What do I do?

Answer:  If not an emergency, call Student Health Services and make an appointment.  Take your SISIP and/or your private insurance ID card with you. If you are experiencing a medical emergency on campus, please contact Campus Police Services by dialing 9-1-1 from any campus phone or by dialing (609)-771-2345 from a cell phone.  Check with your insurance company regarding coverage for Emergency Room and ambulance transport.

Question:  How about if I live an hour away and I get sick?  Or what if I get sick when Student Health Services is closed?

Answer:  If not an emergency, call your doctor or local urgent care facility and make an appointment to be seen.  Take your SISIP and/or your private insurance ID card with you.  If not in network some doctors’ offices will ask that you pay them up-front for your visit.  Please refer to you insurance plan details regarding what is covered or excluded and what co-pays, co-insurance, and/or deductibles may apply. View a list of in-network doctors and facilities.  

Question:  What if I have an illness or injury that needs emergency care?

Answer:  Go to the nearest emergency room.  If you are on campus, contact Campus Police Services by dialing 9-1-1 from any campus telephone or 609-771-2345 from a cell phone to summon medical assistance. Take your SISIP and/or your private insurance ID card with you. Check with your insurance company regarding coverage for Emergency Room and ambulance transport.

Question:   I need to see a dermatologist for a rash I have.  Will SISIP cover these visits?

Answer:  Please refer to your insurance plan details and contact your insurance company if you need clarification regarding coverage.  If you have SISIP, the contact number for UnitedHealthcare Customer Service is 1-800-505-4160.

Question:  What if my doctor orders laboratory tests when I’m sick?  Is this covered?

Answer:  Please refer to your insurance plan details and contact your insurance company if you need clarification regarding coverage.  If you have SISIP, the contact number for UnitedHealthcare Customer Service is 1-800-505-4160.

Question:   Can I use the SISIP Prescription Card to pay for a prescription that was ordered by a doctor outside of Student Health Services?

Answer:  Please refer to your insurance plan details and contact your insurance company if you need clarification regarding coverage.  If you have SISIP, the contact number for UnitedHealthcare Customer Service is 1-800-505-4160.  In most cases if the prescription is being filled at an in-network retail pharmacy, the prescription would be covered but would be subject to co-pays based upon the tier of the prescription as detailed in your plan.    Prescriptions associated with exclusions under the policy are not covered.   See a list of in-network retail pharmacies.

Question:   I need a physical examination to study abroad.  Will SISIP cover it?

Answer:  An annual physical examination  is typically covered under the Wellness portion of your plan. Please refer to your insurance plan details and contact your insurance company if you need clarification regarding coverage.  You can also schedule most curriculum required physical examinations at Student Health Services as long as you are currently taking classes.  There may be a charge for this service.  Please contact Student Health Services with any additional questions.

Question:  Can I still use Student Health Services if I waive enrollment in SISIP or if I am a part-time student?

Answer:  Yes.  Any TCNJ student currently taking classes can use Student Health Services.  See price list.

Question:  Why is the Student Injury and Sickness Insurance Plan (SISIP) so important at TCNJ?

Answer:  Aside from complying with the law by offering the health insurance coverage to all full-time students, not all students have access to health insurance coverage. This can severely restrict their ability to access medical care, or can result in students and their families incurring significant expenses for care.  In some cases, where students do have insurance on their own or through parent/guardian plans, the coverage may not be sufficient or may carry higher co-pays and deductibles, or exclude coverage in certain instances.  Every student should review any health insurance coverage that they have or that is being offered and determine if their insurance is appropriate for them.

Question:  Can I use SISIP outside of the U.S.?

Answer:  Yes, you can submit bills for covered health care services provided by a licensed health care provider located anywhere in the world.  Refer to your plan for details. Please contact UnitedHealthcare BEFORE leaving the U.S. to discuss coverage.

Question:  I won’t be using Student Health Services (SHS) when I’m sick because I have my own doctor. So I won’t need student insurance, right?

Answer:  First, SISIP can be used off-campus.   Second, using Student Health Services is usually much more convenient if you live on-campus or if your doctor is some distance from the College.   Student Health Services’ nurse practitioners and physician have the advantage of knowing what infections are circulating on campus and they are specialists in adolescent and young adult medicine. This gives SHS’ clinicians a tremendous edge when diagnosing a student’s illness. Sometimes, a sudden or severe illness or injury may not provide you with time to get home to see your own doctor.   Lastly, you never know when you may need first aid while on campus.

Question:  If I keep SISIP, should I still bring my other health insurance cards with me to school?

Answer:  Yes.  You should always carry all health insurance cards (Medical, Dental, and Prescription) or a copy of the front and back of the cards with you.  Please learn some basic facts about how your insurance works.

Question:  What if I don’t have any other insurance?  Is SISIP adequate?

Answer:  All students should be reminded that the Federal Government still requires that all citizens be covered by a PPACA compliant plan or they will be subject to tax liabilities beginning January 2014.  Students are encouraged to review their insurance options prior to waiving or enrolling in the plan offered through The College.

Individual health care needs vary among our students. Therefore carefully review the coverage, policy limits, and exclusions of SISIP.  For more information, you may also log on to the New Jersey Department of Banking and Insurance,  eHealthInsuranceHealthcare.gov , and MyInsuranceExpert.com  for information on health insurance.

Question:  Who can enroll in SISIP?

Answer:  The TCNJ student health insurance plan is only available to all currently enrolled full-time students.

Question:  How do I enroll in SISIP?

Answer: Full time students will be automatically billed for student health insurance on their tuition bill.   To enroll in SISIP, prior to September 13, 2017, go to First Student.  Select “The College of New Jersey”. Click “Enroll Now – Health Insurance”.  Follow the instructions to enroll, after which an email will be sent to you with instructions on accessing your insurance cards, etc.  After September 13, 2017 if you have not waived out of the plan, you will be automatically enrolled and an email should be sent to you with instructions on accessing your insurance cards, etc.

Question:  I was told that as a full-time student I was billed for SISIP but where are my insurance cards?

Answer:  Being billed for SISIP is not the same as enrolling in your plan.  To enroll in SISIP before September 13, 2017, go to First Student.  Select “The College of New Jersey”. Click “Enroll Now – Health Insurance”.  Follow the instructions to enroll, after which an email will be sent to you with instructions on accessing your insurance cards, etc.  After September 13, 2017 if you have not waived out of the plan, you will be automatically enrolled and an email should be sent to you with instructions on accessing your insurance cards, etc.

Question:  Do I have to have health insurance to attend college?

Answer: Please refer to Student Health Insurance Laws for more information.

Question:  Can I enroll in SISIP if I am only taking one class?

Answer:   No. Enrollment is limited to full-time students.  Part-time students are not eligible to participate.

Question:  Is SISIP a secondary policy, like athletic insurance?

Answer:   No.  SISIP can be used as a stand-alone plan or as a supplement to other existing insurance.  When using this policy in conjunction with other insurance, you must be certain to abide by all terms and conditions of your insurance.

Question:  Does SISIP pay for prescription medicines?

Answer:  Please refer to your insurance plan details and contact your insurance company if you need clarification regarding coverage.  If you have SISIP, the contact number for UnitedHealthcare Customer Service is 1-800-505-4160.

Question:  Does SISIP cover vaccinations?

Answer:   Under the Affordable Care Act requirements for preventive service SISIP is required to provide participating individuals with access to the vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control & Prevention (CDC) prior to September 2009 with no co-payments or other cost-

sharing requirements when those services are delivered by an in-network provider.  New health plans like SISIP will be required to cover new ACIP recommendations made after September 2009 without cost-sharing in the next plan year that occurs one year after the date of the recommendation.

See a list of ACIP-recommended vaccinations.

Question:  Does SISIP include dental and vision coverage?

Answer:  Yes and No.  Pediatric dental and vision benefits are included for individuals under the age of 19.  For all others participation in SISIP includes discount plans for dental and vision coverage at specific providers.  Please refer to discount plans for additional details.

Question:  How long do I have to send in a claim form to get my bills paid?

Answer:  When you use your insurance card at a medical provider, many providers should submit the claim directly to UnitedHealthcare.  If the provider bills you directly or makes you pay up front, you should contact UnitedHealthcare to see how to submit the claim.  For additional information on how to file a medical claim, please refer to File a Medical Claim.  Be aware that you may have individual responsibilities for payment for medical care due to plan limits, exclusions, co-pays, or deductibles.

Question:  Does the SISIP prescription coverage pay for birth control prescriptions?

Answer:  Yes.  Under the Affordable Care Act as a preventive service for women, contraception, including Food and Drug Administration-approved contraceptive methods, sterilization procedures, patient education and counseling, and abortifacient drugs, are covered 100% with no cost-sharing (no copayments, deductibles, or coinsurance).

Question:  What if I have a complaint about SISIP.  Who do I contact?

Answer:  Although SISIP is offered by the College, it is an individual plan established with UnitedHealthcare.  If you are not able to resolve an issue with UnitedHealthcare, as the servicer of the plan, complaints about UnitedHealthcare can be directed to First Risk Advisors at 267-880-2300. In the event that you need assistance from the College in association with claims associated with services received on campus, or if you have a general concern regarding First Risk/UnitedHealthcare, please contact Student Health Services at 609-771-2889 or via email at health@tcnj.edu.

Question:   Does SISIP cover pre-existing conditions?

Answer:  Under the Affordable Care Act, health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a “pre-existing condition” — that is, a health problem that developed before the child applied to join the plan.  Please refer to your insurance plan details and contact your insurance company if you need clarification regarding coverage.  If you have SISIP, the contact number for UnitedHealthcare Customer Service is 1-800-505-4160.

Question:  I am playing NCAA football at TCNJ.   Will SISIP cover me if I get hurt?

Answer:  No.   SISIP will not cover injuries that result from intercollegiate sports; only those sustained during intramural and club sports.   The College provides athletic insurance for intercollegiate sports injuries which is an excess policy after private insurance.   Athletic injuries and the insurance are coordinated by TCNJ’s Head Athletic Trainer, Megan Guicheteau, at  609-771-3402.

Question:  I was covered by my mother’s health insurance plan through her job and as a current full-time student I waived out of SISIP.  But my mother lost her job and her health insurance coverage was just terminated. The enrollment period has passed and I need health insurance coverage. What do I do?

Answer:  If you want to pursue coverage through the plan offered by UnitedHealthcare through The College, obtain the health insurance termination letter that your mother received and provide it to TCNJ Student Accounts, 119 Green Hall.  If the letter is acceptable evidence of a termination of health insurance coverage, Student Accounts will enroll you in SISIP and charge you a pro-rated premium. Your coverage becomes effective the same day that you login to UnitedHealthcare’s site and activate your plan.  This must be done within 30 days of losing coverage.  After 30 days, you will no longer be eligible to enroll until the following academic year.

If you do not want to pursue coverage through the plan offered through The College, you may be able to enroll in the healthcare exchanges.  While the open enrollment period for the healthcare exchanges for 2017 is closed, you may be eligible for a special enrollment due to a life change given your parent/guardian policy coverage is being terminated.  Obtain the health insurance termination letter from your parent/guardian plan.  Visit http://www.healthcare.gov for additional information.

Please also note that the PPACA expanded Medicaid eligibility in many States including NJ.  To determine if you might be eligible for the expanded Medicaid coverage, you will also need to apply through your state healthcare exchange.  To access your state’s health insurance exchange, please refer to http://www.healthcare.gov.

Question:  Where can I find out more about benefits, coverage, claims procedures, and exclusions about SISIP?

Answer:   Go to the UnitedHealthcare website at First Student.  Select The College of New Jersey from the dropdown list.   To speak to a live Customer Service Representative, contact UnitedHealthcare Customer Service at 1-800-505-4160, 8am-8pm EST.

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