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Health Clearance & Health Insurance

 

Health Clearance Form

Once you have been officially accepted as an inbound exchange student to UHM, please remember to complete the Health Clearance Form. You will find the form online at http://www.hawaii.edu/myuh/healthform/. 

It is OK to submit this form after the deadline, but please send it to University Health Services as soon as you can. If you cannot send it by the deadline, it is highly recommended that submit the form before you register for your UHM courses. University Health Services Manoa does NOT accept this form by email - please mail or fax.

The Health Clearance Form is five pages long, but you only need to submit two pages.  The first page contains useful information. The two pages that you need to return to University Health Services Manoa are pages 2 and 3. These are the “Health Clearance Form” and the “Immunization Record,” and are actually numbered “1 of 2” and “2 of 2."  

  • You may disregard part I ("Tuberculosis Control"), as you will take care of this part after you arrive at UHM -- you will be required to report to University Health Services tor a tuberculin (TB) skin test.
  • You must complete Part II ("MMR") and provide your MMR (measles, mumps, rubella) immunization record. You can either A) have your health care provider complete this page of the Health Clearance Form, B) submit a copy of your school or public health immunization record, or C) submit a copy of a health care provider's record.
  • The "Health Insurance" information on page 4 is primarily intended for U.S. citizens; unless you are a U.S. citizen, you do not need to complete the "Health Insurance Information Sheet" on page 5.

 

Health Insurance for International Students

International students must meet certain minimum health insurance coverage requirements. You will find more information about this at the UHSM website (http://www.hawaii.edu/shs/).  Use the link on the left for “International Student Insurance.” 

There you will find the requirements (click link for “Insurance Requirements”) for both F-1 and J-1 students. (You are an F-1 student if you received an I-20 form; you are a J-1 student if you received a DS-2019 form.) You will also find the minimum requirements listed on the F-1 and J-1 Health Insurance Provider Certification forms.

  • F-1 students can purchase the UH Student Plan (HMSA) or have your insurance provider complete an F-1 Student Acknowledgement & Insurance Provider Certification Form in order to prove that your current health insurance policy meets UHM's requirements. You can download this form at the following website: http://www.hawaii.edu/shs/international.html. You must visit the Student Health Insurance Office at QLC 313 to submit the Provider Certification Form and receive your health insurance clearance. The Student Health Insurance office email is shio@hawaii.edu.
  • J-1 students can purchase the UH Student Plan (HMSA) or have your insurance provider complete the J-1 Health Insurance Provider Certification Form as outlined at the ISS website. Please also read the J-1 FAQ on the ISS website. You must visit the International Student Services (ISS) Office at QLC 206 to submit the Provider Certification Form and receive your health insurance clearance. The email for ISS is issmanoa@hawaii.edu.

It is important that you send your Health Clearance forms to University Health Services Manoa before registration begins and that you submit your proof of insurance (proof of purchase of UH Student Plan or Provider Certification Form) to either the Student Health Insurance Office (F-1 students) or to ISS (J-1 students) as soon as possible after you arrive. 

Alternate Health Insurance: If you do not plan to purchase the UH Student Plan and are considering purchasing alternative health insurance, ISS lists two alternative plans that meet both the J-1 federal and F-1 UH policy student health insurance standards.

  • HTH Worldwide Hawaii HealthCare Value Plan - This plan was designed for UH students. The plan is both comprehensive and affordable, with a set monthly price. This plan meets all mandated benefits as required by the University of Hawaii and the Hawaii State Insurance Commission. There is a 6-month waiting period for pre-existing conditions.