ENTRANCE HEALTH AND INSURANCE REQUIREMENTS AND REQUIRED FORMS FOR NEW AND TRANSFER STUDENTS

Dear Incoming Emory New or Transfer Student:

Welcome to Emory!  We hope that your time here will be healthy, happy and always intellectually stimulating.  In previous years, we have mailed health information and required health history and immunization forms to incoming students.  However, we have found that these packets sometimes get lost in the mail and/or do not reach students prior to their arrival in Atlanta.  In addition, some students need forms early due to medical appointments, summer travel, or the like.  Therefore, we now provide these forms on-line via our Emory University Student Health and Counseling Services (EUSHCS) home web site, so that you can download, print and complete the forms and mail them back to us.  For all new and transfer students, your Entrance Health History form will be completed on-line via our confidential/secure MedBuddy-U communication system.

In order to complete your pre-matriculation Student Health forms, please take the following seven steps. (Please note: the forms are in PDF format and Adobe Acrobat Reader is required).

Step One:  Immunization and Consent for Treatment Forms
Step Two:  Authorization for Use/Disclosure of Protected Health Information Form
Step Three:  The State of Georgia Meningococcal Vaccination Acknowledgement Form for Students Living in On-Campus Housing
Step Four:  Complete Your Student Health Insurance Requirement Compliance Process
Step Five:  Complete Your Entrance Health History On-Line Via the MedBuddy-U System
Step Six: Mail Your Forms to EUSHS
Step Seven: You're Finished!

Step One:  Immunization and Consent for Treatment Forms

Download this 2-sided form, print and complete both pages, being sure to get signatures from your healthcare provider to verify the accuracy of your immunization records and, if required for your individual school/college, your tuberculosis screening records.

Immunization and Consent for Treatment Forms

As you will see from the Immunization and Consent for Treatment Forms, you have a number of immunization series to complete (either before or after your arrival here). If you have started but not yet completed your required immunizations, all needed vaccinations are available at Emory University Student Health Services. If you have questions about the immunization requirements, you may call our Immunization Nurse at (404) 727-0392.

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Step Two:  Authorization for Use/Disclosure of Protected Health Information Form

Download the form, print and complete both pages (you might also want to make a copy for your records):

Authorization for Use/Disclosure of Protected Health Information Form

This document is required by the Health Insurance Portability and Accountability Act (HIPAA) of April 2003 and we apologize for its complexity and length. If it helps you, choosing the first option in each section of the authorization form will allow us to handle your Protected Health Information in the same confidential and concerned manner that we have always utilized in the past. However, it is your right under the new law to be more specific and restrictive in your authorization and EUSHCS will make every effort to follow your wishes and directives. In order to complete this form, your might want to review the following Emory Healthcare Notice of Privacy Practices and print and keep a copy for your records:

Emory Healthcare Notice of Privacy Practices

Step Three:  The State of Georgia Meningococcal Vaccination Acknowledgement Form for Students Living in On-Campus Housing

If you will be living in Emory on-campus housing, State of Georgia law (Official Code of Georgia Annotated 31-12-3.2) requires that you receive information about meningococcal meningitis and the vaccine and that you sign a document stating that they have either received a vaccination against meningococcal disease or reviewed the information and declined to be vaccinated. You should download, print and complete this State of Georgia form by going to:

The State of Georgia Meningococcal Vaccination Acknowledgement Form for Students Living in On-Campus Housing

To review important facts about meningococcal meningitis and meningococcal disease, you should review the following:

Important Facts About Meningococcal Disease

Step Four:  Complete Your Student Health Insurance Requirement Compliance Process

All new, transfer and continuing degree-seeking and all international Emory University students (including Oxford College) are required to have health insurance.   Under this requirement, students must either purchase the Emory University Student Health Insurance Plan (offered by Aetna Student Health) or provide documentation of enrollment in a comparable United States-domiciled plan.  For information about the Student Health Insurance Requirement, including deadline dates for your starting semester, insurance plan billing and Emory Student Health Insurance Plan annual premiums, click here.

If you wish to substitute your own insurance plan to meet this requirement, go to www.opus.emory.edu to complete the waiver process on-line.   

If a student has not waived out of the Emory Student Health Insurance Plan by the deadline date, he/she will be automatically enrolled in the annual Emory/Aetna plan for the academic year and billed by the Emory Student Financial Services (SFS). 

Students will need to complete the annual insurance enrollment/waiver process each year they are enrolled at Emory. If the student wishes to be enrolled in the Emory University Student Health Insurance Plan, that enrollment will happen automatically at the end of the waiver process.

In order for an insurance plan to meet the Emory University mandatory insurance waiver criteria, the insurance plan must feature, at a minimum, all three of the following:

1. Coverage that allows the insured student to receive outpatient, emergency, specialist and inpatient care, diagnostic testing and procedures, and mental health inpatient and outpatient care, including alcohol and substance abuse treatment, in Atlanta, GA
2. A deductible not greater than $2,500 per policy year.   If the annual deductible exceeds $2,500, the insured student must have an approved Healthcare Savings Account (HSA) that will allow the student to seek needed medical and mental health care when recommended by a healthcare provider and will cover all deductible expenses over $2,500.  
3. The insurance must be provided by an insurance company domiciled in the United States (or must be provided by an international insurance company with a United States partner for handling of insurance claims in the United States).

For information about the Aetna health insurance plan offered for Emory students click here, or go to www.aetnastudenthealth.com (click on Find Your School and choose Emory University). There is also information about insurance, EUSHS fees and billing practices on our web site click here.

Step Five:  Complete Your Entrance Health History On-Line Via the MedBuddy-U System

You will now complete your Entrance Health History Form on-line. Go to the Student Health Services home on our EUSHCS web page. Once there, click on the MedBuddy-U icon in the upper right corner to register. When you reach the sign in screen and register with MedBuddy-U for the first time, click the “First Time User” button. Please use your standard Emory Network ID (also called your “User Name”) as your MedBuddy-U ID.For example, if your name is Jane Doe and your new Emory e-mail address is jdoe@emory.edu , then your Emory Network ID is jdoe. You will also need to create a MedBuddy-U password. Please be aware that your password should be kept confidential. If you share it, others will potentially have access to your personal health information. In order to complete your required Entrance Medical History, you must answer all questions in red.

Step Six: Mail Your Forms to EUSHS

Mail (or hand deliver if you are already in Atlanta) your completed Immunization and Consent for Treatment Form (with the signature of your doctor or healthcare provider), your 2-page Authorization for Use/Disclosure of Protected Health Information and your State of Georgia Meningitis Form to:

Director of Nursing Services
Emory University Student Health Services
1525 Clifton Road
Atlanta, Georgia 30322

We must receive these forms prior to the start of your classes.

Step Seven: You're Finished!

That's it! If you have followed the above steps, and provided Student Health Services with your health forms, you are all done! Please feel free to contact us at EUSHCS at (404) 727-7551 if you have questions about Student Health Services, the on-line MedBuddy-U health history form, the above health forms and brochures, meningococcal meningitis and the vaccine, student health insurance and the mandatory health insurance requirement or any other student health-related issues. Once again, we welcome you into our Emory family!

Yours very truly,
Michael J. Huey, MD
Executive Director
Emory University Student Health and Counseling Services
Clinical Assistant Professor
Department of Family and Preventive Medicine 

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© 2008 Emory University, Atlanta, GA
Revised 5/14/2008