Mandatory Health Insurance Policy - Vcu School Of Medicine
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1
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3Virginia Commonwealth University School of Medicine
Proof of Health Care Coverage, Compliance Form
This form is designed to assist students in complying with the Virginia Commonwealth University School of
Medicine policy, which mandates that all medical students shall have and maintain health insurance
coverage. The policy sets forth the minimum insurance requirements for all enrolled medical students.
Students must verify that the basic benefits outlined in the form are included in their health insurance
policy and provide documentation that their policy provides those benefits necessary to meet the
established requirements. If any of these benefits are not covered, a hold will be placed on the student’s
account (registration) until proof of sufficient coverage is received in this office. This hold means that you
cannot attend classes or participate in clinical activities, and you will not be eligible to receive financial aid.
Please allow sufficient time to process this form.
INSTRUCTIONS TO STUDENTS
1) Please contact your insurance company and speak with an agent/representative to review and assist in
the completion of the form on page three (3). In order for a policy to be consider compliant, the
questions contained on the form should receive a response of “Yes”.
2) Please request a Certificate of Group Health Plan Coverage from your insurance agent/representative.
The Certificate should be submitted with the form (page 3). The certificate should contain the
following information:
a. Date of the Certificate
b. Name of Health Plan
c. Name of the Participant
d. Identification Number of the Participant
e. Name(s) of the Covered Dependent(s) to whom this Certificate applies
f.
Plan Administrator (include name, address and telephone number)
g. Date Waiting Period (if any) began
h. Date Coverage began
i.
Date Coverage will end
3) A health Insurance card will not be considered an acceptable form of Proof of Health Care Coverage.
4) Please return this entire form and the Certificate of Health Care Coverage to:
Carol L. Kennon
Office Administrative Support Technician
VCU, School of Medicine
Student Affairs Office
th
1201 E. Marshall Street, 4
Floor, Suite 200
(PO Box 980565)
Richmond, VA 23298
Or you may email the information to carol.kennon@vcuhealth.org or fax to (804) 828‐5115
If you have any additional questions or need assistance with regard to this compliance policy, please
contact Carol Kennon at (804) 827‐1260, or the University Student Health Services office (804) 828‐8828.
Share (T:)/Deans Office/studentaffairs/Carol/INSURANCE/2016‐17 Proof of Insurance.pdf Ed. 04/2016
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