Extension of SHP Coverage for an Approved Leave of Absence If you are taking an approved leave of absence, you may be eligible to receive an extension of your medical and prescription benefits through the Student Health Plan.You must be enrolled in the plan at the time of your leave.You must meet all extension criteria.You must submit an application to extend coverage. You may take one $0 cost extension for up to 6 consecutive months.You may take one subsequent extension for up to 6 consecutive months at full cost to you.Both extensions are a one-time benefit per academic lifetime.While on an extension, you may use the Student Health Plan for off-campus services, with no referral required. Extension Criteria As a degree-seeking student (and any dependent) enrollee, you are eligible for this benefit if you meet all of the following criteria:Have an approved leave statusAre a degree-seeking studentDo not have comparable coverage to the SHPPlan on returning to the University to continue your educationIf there is a status change at any point during the extension period, and you no longer meet the extension requirements:Your SHP extension enrollment will be terminated effective the date of your status change. A prorated refund for the SHP will be placed on your account, if applicable. Extension Period - $0 Cost Extension If you are an enrollee on an approved student leave of absence and do not have comparable coverage to the SHP available, you may continue SHP coverage for up to 6 months at $0 cost. You must be enrolled in the SHP at the time of your leave to be eligible for this benefit.Application is required within 45 days of your leave of absence date. The extension is not automatic.The $0 cost extension is a one-time benefit per academic lifetime.Your SHP coverage will remain in place through the end of the semester of the approved leave, and the SHP plan fees will be retained for that semester.If you have a financial aid package that includes the cost of the Student Health Plan, please check with the Financial Aid Office to inquire if this enrollment change will impact your aid package.The $0 cost extension would begin the semester that follows the approved Leave of Absence (either February 1 or August 1).Example: if a student’s approved Leave of Absence is November 1st, SHP coverage will continue through January 31st (the end of the Fall coverage period). The SHP fees will be retained through January 31st. The $0 cost 6-month extension would begin February 1st.Example: if a student’s approved Leave of Absence is June 1st, their coverage will continue through July 31st (the end of the Spring coverage period). The $0 cost 6-month extension would begin August 1st. Note: The dates used in the above examples are for informational purposes only. The Graduate School or the Office of the Dean of the College would first need to approve your Leave of Absence in accordance with their established policies. Extension Period – Subsequent Extension (Fees Applicable) For subsequent approved leaves of absence, enrollees may be eligible to extend their SHP coverage for an additional 6 months at cost to them.You must be currently enrolled in the plan.You must meet all extension criteria.You must submit an application within 30 days of your leave, or 30 days prior to the termination of the $0 cost extension.You may take one subsequent extension for up to 6 consecutive months at full cost to you.Fees for the subsequent extension will be billed in full to your student account.Subsequent extension is a one-time benefit per academic lifetime. Required Application and Attestation Process The 6-month extension is not automatically applied. Application for the first 6-month extension must be completed within 45 days of the approved leave of absence. Application for the subsequent 6-month extension must be completed within 30 days of the approved leave of absence.If you intend to also extend your enrolled dependentsSpouse and/or children under the age of 26, you must elect it on your application. If an application is not completed, coverage terminates at the end of the semester of the approved leave.The Application for Extension of SHP Coverage is accessible through the MyUHS online portal under "Forms". Extension Cost and Billing Coverage for the first 6 months will be provided at no cost to the student. Coverage for an additional 6 months is available if:The student remains on an approved leave of absence. application for the subsequent extension is completed within 30 days prior to the end of the first 6-month period.The subsequent 6-month period will be billed to the student’s account. DependentFirst 6 Month RateSecond 6 Month RateStudent$0$1,755Spouse$1,215$1,215Child$608$608Children (2)$1,215$1,215Children 3+$1,823$1,823If an extension continues into the next plan year, extension fee may be adjusted based on the next plan year fee schedule, if applicable, and will include the application of new plan year deductibles. Vision and Dental Coverage If you are currently enrolled in the dental and/or vision plans, coverage will continue in line with the SHP, but will not extend into the next plan year. Have questions?If you have questions about the SHP Extension of Coverage, contact the SHP Office at [email protected]. Extension of SHP Coverage due to Medical Disability If you are separating from the university and require continuation of coverage for treatment of an existing medically disabling condition, you may apply for a 90-day extension of coverage. The extension is not a full extension of benefits and will only cover treatment of the medically disabling condition. Extension allows use of the Student Health Plan for off-campus services only and referral is not required. Extension Criteria As a degree seeking student (and any dependent) enrollee, you are eligible for this benefit if you meet all of the following criteria:Are a degree seeking studentYou have a documented medically disabling condition or become confined to a hospital andYou have received medical treatment for that condition within 30 days of your SHP terminationThe condition has been documented by your treating medical provider. This documentation must be supplied to the SHP office at the time of your extension applicationYou will not be returning to the university Extension Period The coverage will continue for a period of 90 days after your scheduled SHP termination date. Required Application Application is required within 30 days of your scheduled SHP termination date. Application for Extension of SHP Coverage is accessible through the MyUHS online portal under "Forms". Select the 90-Day Extension of Coverage due to Medical Disability option. Extension Cost and Billing Full payment for the extension must be received by the SHP Office within 30 days prior to your scheduled SHP termination date. Dependent90-Day Extension RatesStudent$878Spouse$608Child$304Children (2)$608Children (3)$912If the 90-day extension continues into the next plan year, the 90-day fee may be adjusted based on the next plan year fee schedule, and will include the application of new plan year deductibles. Essential Information Application for Extension of SHP Coverage Termination of Coverage Student Health Plan (SHP)