Forms

Summer 2022 Enrollment/Waiver Period:

May 13th - June 24th

Summer 2022 Coverage Dates:  May 14th - August 19th

All students billed the UIUC Student Insurance fee per semester will be auto enrolled once the Enrollment/Waiver period closes unless they opt out.

If you successfully opted out during the Fall Enrollment Period and wish to remain opted out, you do not need to take any action.  

Students will receive (6) weekly emails during the Enrollment Period, outlining all of the options and resources available to them.  Please pay attention to these emails and contact our office with any questions.  

 

Early Arrival Coverage - Fall 2022

THIS FORM HAS NOW CLOSED FOR SUMMER!

THE FALL EARLY ARRIVAL PURCHASE OPTIONS WILL OPEN ON JULY 21, 2022!

The Summer 2022 early arrival coverage can be purchased here https://www.uhcsr.com/illinois

View the step-by-step instructions document for assistance with purchasing early arrival coverage.

Undergraduate 14 Days August 6th  – August 20th

  • Student $100
  • Spouse or One Child $86
  • Two or More Children $172
  • Spouse and 2 or More Children $258

Undergraduate 30 Days July 21st  – August 20th

  • Student $192
  • Spouse or One Child $178
  • Two or More Children $356
  • Spouse and 2 or More Children $534

Graduate 14 Days August 6th - August 20th

  • Student $125
  • Spouse or One Child $111
  • Two or More Children $222
  • Spouse and 2 or More Children $333

Graduate 30 Days July 21st - August 20th

  • Student $244
  • Spouse or One Child $230
  • Two or More Children $460
  • Spouse and 2 or More Children $690
Enrollment Form

Please note students may only opt in during the Enrollment/Waiver period listed above at https://studentcenter.uhcsr.com/illinois.

The Enrollment Form must be filled out during the Enrollment/Waiver period, prior to adding dependents or printing off your ID Card.  

If you need to receive medical services prior to the end of the Enrollment Period, please complete and submit this form.  Otherwise, you will be auto-enrolled with 3 business days following the end of the Enrollment Period.

Opting Out of Coverage

Students needing to opt-out may only due so during the Enrollment/Waiver Period listed above at https://studentcenter.uhcsr.com/illinois.

In order for a Waiver to be approved, students must provide proof of being actively enrolled in a comparable plan.  

Comparable Requirements: 

Must be a US-based plan with a US phone number. Coverage must be effective on or before the 1st day of the Semester and extend through the remainder of the Academic Year.  Must provide access to in-Network emergent AND non-emergent care within a 50 mile radium of the UIUC campus.  Must be compliant with the Affordable Care Act (ACA).
  • Including but not limited to: 
    • unlimited lifetime benefits
    • no restrictions on preexisting conditions
    • provides benefits for mental health care services

Note:  Approved waivers apply only to the Academic Year during which they were approved.  If you were approved for a waiver during the 2020-2021 Academic Year and wish to remain opted-out of UIUC's plan, you must repeat the Opt-Out process for the 2021-2022 Academic Year.

If your waiver request was denied, and you believe this decision was reached in error, you must contact United Healthcare Student Resources. 

UHCSR Customer Service:  waiververification@uhcsr.com

Once a Waiver has been approved, allow 7-10 business days for the fee to be refunded. 

Adding a Dependent

You may only add a dependent once you have opted in each semester!

Please only submit documentation one time and allow up to three business days for processing at https://si.illinois.edu/depverify

If you are a newlywed or have a newborn, please email us at insure@illinois.edu listing your UIN, the name of your dependent, and provide us with one of the documents listed below within 30 days.

You must first confirm your enrollment with UnitedHealthcare by filling out the enrollment form /links-and-forms. Once that has been completed you will be able to follow the instructions for dependent verifications.

At least one of the documents listed below must be provided for each dependent, in English, prior to their enrollment being completed.

Acceptable Documents to add dependents:

Marriage Certificate, Birth Certificate, 1040 Tax Return (1st and last pages w/signatures), J1 or F1 Visa (needs to include dependents name), Civil Union Certificate, Military Discharge Papers, MD Attestation for disabled dependents over the age of 26), Guardianship Court Order or Letter signed by a judge, awarding legal guardianship.

Domestic Partnership- at least 3 of the below documents must be submitted:

Joint Mortgage or Lease, Life Insurance Beneficiary Designation, Primary Beneficiary (Will) Designation, Domestic Partnership Agreement, Power of Attorney of Property and/or Health Care, Joint Ownership of either a motor vehicle, checking account or credit card.

Extending Coverage

If you are not enrolled for classes for an individual Semester and wish to extend your coverage, you can purchase an Extension.  However, you must have been covered during the previous Semester and plan on returning the semester following as a on campus student.

If you wish to purchase the Extension you may do so using the appropriate web form below May 02, 2022 - June 24, 2022: 

Undergraduate Extension: https://si.illinois.edu/undergrad-summer-extension

Graduate Extensionhttps://si.illinois.edu/grad-summer-extension

Continuation of Coverage
If you were enrolled in the Student Health Insurance plan, and wish to continue coverage after graduation, you can purchase coverage for up to 90 days (30-day increments). Please login to your My Account through the UHCSR website. https://www.uhcsr.com/illinois.
Reinstating Coverage

If you opted out of UIUC Student Health Insurance and wish to enroll for coverage during the Enrollment/Waiver period listed above, you can do so here: UIUC Reinstatement Form.

If you have had a loss of other insurance outside our Enrollment/Waiver period and you are registered for on campus classes, please contact our office for assistance.

ID Cards

UnitedHealthcare Student Resources (UHCSR) will NOT automatically send you an insurance ID Card.  You must create a My Account through UHCSR, and from there you will be able to print your ID Card. Go to https://www.uhcsr.com/school-year click on log in to either log in or create an account.