Enrolling in or Waiving SMIP

Students who already have medical insurance may be able to opt out of the Duke SMIP by submitting a waiver request.  As we want to ensure students have adequate, in network coverage here at Duke, your existing insurance must meet specific criteria in order for that waiver request to be approved.

The criteria for students to have a waiver request approved are:

• Student must not be attending Duke on an F1/J1 visa
• Plan must be in compliance with the Affordable Care Act (ACA Compliant)
• The claims administrator of the plan is based in the United States, has a U.S. telephone number and address for submission of claims, and the insurance policy has not been issued outside the U.S.
• The policy is not a traveling policy.
• The plan provides unlimited emergency and non-emergency routine health care and mental health benefits in the Durham, NC area, including at Duke Medicine. (In order to meet these criteria, your plan must provide in network benefits at Duke Health facilities for the following services: Primary Care Doctors office visits, Specialty office visits, Preventative care office visits, Lab services, X-rays, and imaging)
• The plan provides inpatient and outpatient mental health care (with at least 30 visits per year) with chemical dependency benefits that are comparable to the coverage provided by the Duke SMIP.
• The plan provides unlimited coverage for prescription medication.

NOTE: these criteria apply to all plan types without exception, including Medicaid, Medicare, TRICARE/military, HMOs (including Kaiser, WHA, and others), U.S. federal or state exchange plans, and all employee-sponsored and individual plans.  Out-of-state Medicaid and state Children’s Health Insurance Plans, HMOs, and Kaiser Permanente insurance plans do not cover non-emergency care in Durham and will not qualify for a waiver.