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IMPORTANT
Policy For F-1 Students Who Have Their Own Health Insurance
As a condition of registration, UCLA Extension requires all international students on F-1 student visas to have adquate medical insurance coverage while in F-1 status. To qualify, your own medical insurance plan must include ALL four of following minimum acceptable benefits:
1. Must be medical/health insurance plan purchased in the U.S. with a U.S. insurance company. Foreign insurance with U.S. affiliates/representatives, travel insurance, and reimbursement programs of any kind are not acceptable. This includes reimbursement arrangements of vouchers from home governments or their U.S. based consulaes.
2. Must provide a minimum of $100,000 in lifetime benefits.
3. Must cover at least 75% of your medical expenses, have a deductible of $500 or less, and copayment of 20% or less.
4. PRO/HMO health care facilities must be located within 25 miles of UCLA,.
Please be aware that many U.S. hospitals and medical institutions do not accept health insurance policies from other countries. To avoid being turned away by the hospital in case of emergencies, you must be covered at all times during your F-1 status. You can purchase an insurance policy is offered by "HTH Worldwide Insurance Services," UCLA Extension also requires medical insurance for dependents.
You have the opinion of providing your own health insurance. Your own health insurance policy must meet ALL four of the minimum acceptable benefits listed above. Should you elect to purchase your own health insurance policy, please sign the statement below and return it to this office along with written proof that the benefits listed above have been satisfied.
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I understand I am fully responsible for my own health insurance coverage during the entire period I am on F-1 visa student at UCLA Extension. My own health insurance policy meets ALL of the minimum acceptable benefits listed above. I also understand I will be responsible for renewing my health insurance if it expires while I am still in F-1 status and that the university is not liable for any of the medical expenses I may incur.
Last Name__________________________________________
First Name__________________________________________
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