Insurance Clearance for F-1 Students

How to Receive Insurance Clearance

The documentation below is required in order to receive clearance for your health insurance requirement. You will be notified within 1-3 business days if your health insurance is approved, denied, or if further information is needed to make that determination.

Your insurance documentation may be faxed, mailed, emailed, or personally delivered to the Student Health Insurance Office.

University of Hawaiʻi at Mānoa
Student Health Insurance Office
2600 Campus Road,
QLCSS Rm. 313-D
Honolulu, Hawaii 96822
Fax: (808) 956-6371
Email: shio@hawaii.edu


IMPORTANT : Due to the large number of students who will be requiring insurance clearance each semester, students should submit their forms early to avoid not being able to register, add and drop courses. We recommend submitting your forms at least 2 weeks prior to your student registration/add/drop period.

Documents Required to Receive Clearance

There are 3 kinds of insurance plans that you can purchase to receive clearance, the UH Student Plan, the UH Employer/Employee Health Insurance Plan (through EUTF) or another insurance company. The documents required to receive clearance are listed below:

UH Student Plan

If you choose the UH Student Plan, you will need to submit the following:

  1. F-1 Student Acknowledgement & Insurance Provider Certification Form and Instructions (PDF) *
    1. Student needs to complete & sign the top portion of the form AND
  2. Proof of enrollment on the UH Student Plan
    *you only need to submit one of the 3 options below
    1. Online Receipt/Confirmation Page OR
    2. A copy of your completed insurance application AND
      receipt showing the amount paid OR
    3. Confirmation letter from an agent at HMSA. Letter must include:
    • Subscriber name
    • Confirmation that you purchased the UH Student Plan
    • Plan start and end dates
    • Benefit option purchased

NOTE: If you purchase this plan by mail you may not receive confirmation from HMSA in a timely manner, which may impact your ability to register/add/drop courses.

Back to Top

UH Employer/Employee Health Insurance Plan (through EUTF)

If you choose the UH Employer/Employee Health Insurance Plan, you will need to submit the following:

  1. For New EUTF Members (if you are applying for the first time or reapplying for this plan)
    1. F-1 Student Acknowledgement & Insurance Provider Certification Form and Instructions (PDF) *
      1. Student needs to complete & sign the top portion of the form.
    2. MEMO (for new EUTF members) (PDF) *
      1. This memo needs to be completed and signed by your department
      2. This shows that you have applied for health insurance, which insurance plan you selected and your employment dates

        EUTF Medical Plans that meet the medical requirements:
        - HMSA 90/10 PPO Plan
        - HMSA 80/20 PPO Plan
        - HMSA 75/25 PPO Plan
        - HMSA HMO Plan
        - Kaiser Standard Plan
        - Kaiser Comprehensive Plan
    3. Proof of repatriation and medical evacuation insurance

      You have to purchase separate repatriation & medical evacuation insurance. Some companies that sell this type of insurance are: International SOS and Basic Emergency Travel Assistance (BETA); HOWEVER, you can purchase this coverage from any company of your choice as long as it meets the minimum requirements ($7,500 USD for repatriation & at least $10,000 USD for medical evacuation.

      Documentation (proof of insurance) should include:

      - Insurance company's name
      - Plan subscriber's name
      - Plan start and end dates
      - Dollar amounts of coverage (at least $7,500 for repatriation & at least $10,000 USD for medical evacuation
  2. For Continuing EUTF Members (if you are already on EUTF & just need to submit updated documents)
    1. F-1 Student Acknowledgement & Insurance Provider Certification Form and Instructions (PDF) *
      1. Student needs to complete & sign the top portion of the form
    2. Copy of your most recent paystub (PDF) *
      1. This shows that you have health insurance (the premiums are being deducted from your pay)
    3. Copy of your health insurance card OR copy of your EUTF Confirmation Notice (PDF) *
      1. This shows that you have a plan that meets the medical requirements

        EUTF Medical Plans that meet the medical requirements:
        - HMSA 90/10 PPO Plan
        - HMSA 80/20 PPO Plan
        - HMSA 75/25 PPO Plan
        - HMSA HMO Plan
        - Kaiser Standard Plan
        - Kaiser Comprehensive Plan
    4. Copy of your Payroll Notification Form (PNF) (PDF) *  OR
      MEMO from your department confirming appropriate start & end date (PDF) *
      (include department contact person)
      1. This shows the dates that you will be covered
    5. Proof of repatriation and medical evacuation insurance

      You have to purchase separate repatriation & medical evacuation insurance. Some companies that sell this type of insurance are: International SOS and Basic Emergency Travel Assistance (BETA); HOWEVER, you can purchase this coverage from any company of your choice as long as it meets the minimum requirements ($7,500 USD for repatriation & at least $10,000 USD for medical evacuation.

      Documentation (proof of insurance) should include:

      - Insurance company's name
      - Plan subscriber's name
      - Plan start and end dates
      - Dollar amounts of coverage ($7,500 USD for repatriation & at least $10,000 USD for medical evacuation)

Back to Top

Other Insurance Plan (all other insurance plans, including other HMSA plans, but not the UH Student Plan or EUTF plan)

If you choose another insurance plan, you will need to submit the following:

  1. Other HMSA Plans (not UH Student Plan or EUTF plan)
    1. F-1 Student Acknowledgement & Insurance Provider Certification Form and Instructions (PDF) *
      1. Student needs to complete & sign the top portion of the form
      2. Insurance company needs to complete & sign the bottom portion of the form
        - Form can be faxed to HMSA: (808) 948-6653; attention: E. Oshimo
  2. All Other Insurance Plans
    1. F-1 Student Acknowledgement & Insurance Provider Certification Form and Instructions (PDF) *
      1. Student needs to complete & sign the top portion of the form
      2. Insurance company needs to complete & sign the bottom portion of the form

IMPORTANT : If your plan does not meet the minimum levels of coverage required or your insurance company will not complete and sign the F-1 Student Acknowledgement & Insurance Provider Certification Form, then your plan will not be accepted for medical clearance.

Back to Top