Information for Students and Parents

 

1. As a college student, what are my health insurance options?

Many colleges, universities, graduate schools, professional schools and trade schools offer a school-sponsored health insurance plan. Many schools require that you enroll in the school-sponsored plan unless you are able to show that you have comparable coverage from another source. If your school offers a student health plan, compare the coverage and cost of the plan with the coverage and cost of other available plans, including any that you may currently be enrolled in (such as a parent's plan). Additional details about what to look for when you are weighing your options are set forth below.

In addition to the option of purchasing a school-sponsored health insurance plan, students may have the option of purchasing health insurance: (a) through a parent's insurance plan, (b) through a plan offered by an employer, if the student is employed, (c) through a public program such as Medicaid, Child Health Plus, Family Health Plus, or Healthy New York, (d) on the individual market, including through state high risk insurance pool programs and temporary high risk insurance pool programs organized pursuant to new federal law until new health care exchanges begin operating in 2014. Students who live in New York may be eligible to remain on a parent's insurance plan through the age of 29. For information about eligibility for public health programs such as Medicaid or Healthy New York, visit www.ins.state.ny.us/chealth.htm.

2. What factors should I consider when I am choosing a health insurance plan?

When you consider which plan is the best option, consider the following factors:

• How much does the plan cost per year?

      Student health insurance plans offered by schools generally range from as low as $200 to more than $2,000 per year.  Importantly, the cost of the plan does not always correlate with the quality of the benefits.

• What are the plan’s coverage limits?

Some plans have overall monetary caps or limits on particular types of services that are far too low to protect students if they become seriously ill or have an accident.  While the new federal health care law places new restrictions on lifetime and annual aggregate coverage caps for "essential health benefits," as defined in forthcoming regulations, be sure to review any plan that you are considering to determine what coverage limitations are included for particular types of coverage.  If your school-sponsored plan does not provide an adequate amount of coverage, you should consider other insurance options as outlined above in no. 1.   In addition, if your school's plan has inadequate coverage, you may also want to make a request to your school that the school switch to a more comprehensive plan. 

• Does the plan cover prescription drugs?

Make sure that you choose an insurance plan that offers a high enough prescription drug benefit to cover your needs.  In general, the benefit should cover, at the very least, $1000 per year.  You can reach that amount with just a few prescriptions, particularly if your doctor prescribes a drug which does not have a generic alternative. 

• Does the plan exclude coverage for pre-existing conditions or for illnesses or injuries common to students?

Some plans exclude coverage for pre-existing conditions.  Starting in 2014, the new federal health care reform law prohibits exclusions for pre-existing conditions.  Some school-sponsored plans also exclude coverage for other types of illnesses or injuries that are relevant to a student population.  Many student health plans have other exclusions which may be unlawful or otherwise improper¹. If your school-sponsored plan excludes pre-existing conditions or includes other improper exclusions, you may want to consider other options.  You also may want to request that your school switch to a plan that does not exclude these conditions.

• Are in-network doctors available in the locale where I will be attending school and when I return home for vacations?

Another factor you should consider when assessing a plan is whether in-network doctors are available in the locale where you will be attending school and in the locale where you reside during vacations from school, including summer vacation.  If you will need to go out-of-network either when you are at home or when you are in school, you should factor in the benefits available for getting out-of-network treatment.

• Is the policy a good deal?

Even if a plan has acceptable coverage limits and doesn’t have exclusions for coverage, the plan could still be too expensive for what you’re getting.  How can you tell?  The best measure of this is something called the loss ratio, i.e. what percentage of the premiums paid to the insurance company are actually paid out in claims. 

Ask your school or the insurer offering the plan what the target loss ratio is for the school-sponsored plan   Under the new health care law, starting in 2011, insurers will have to spend at least 85% of every premium dollar on medical care.  If they don't, they have to rebate the difference to consumers.  If the school-endorsed plan does not currently have a target loss ratio of at least 85%, it is not a good deal for its students.

 

3. My school requires that I enroll in the school-sponsored health plan, unless I can "waive out" by showing comparable coverage. How do I "waive out"?

Every school has its own procedure and requirements for waiving out of school-sponsored health insurance. Be sure to follow all of your school’s waiver procedures, being mindful of deadlines, or else you could wind up paying for a policy you don’t need. Typically, schools with waiver policies will bill you for the school-sponsored student health insurance premium on your tuition bill. If you haven’t already requested a waiver, you then have a certain time period to submit a waiver form. Most schools want you to show that you have coverage which is comparable to the school-sponsored policy. Some schools require that you provide the policy itself, or a policy number, or the school may perform audits to ensure that your coverage is in fact comparable the school-sponsored policy.

4. What if my school requires that I enroll in the school-sponsored student health plan?

Some schools require all students to purchase the school-sponsored student health insurance plan, regardless of whether a student may have coverage through a parent or other source.  If your school requires you to purchase the school-sponsored health plan, you should still review the plan to determine whether the plan provides sufficient coverage to meet your needs.  If the plan does not provide adequate coverage or includes inappropriate exclusions, you may want to consider keeping or purchasing coverage in addition to the school's mandatory plan.  If you do end up with double coverage, find out which of the plans will be considered your "primary" and which your "secondary" insurance.  As noted below, students who receive Medicaid may want to request to "waive out" of school-sponsored plans.  Schools should, and generally do, permit such students to waive out of a school-sponsored plan. 

5. I receive Medicaid benefits.  Will I be able to "waive out" of the school-sponsored plan?

Most schools allow students receiving Medicaid benefits to waive out of the school-sponsored insurance.  However, it is possible that a school could make it difficult for such students to waive out of the school-sponsored insurance. In such a case, while the school may provide financial aid to cover the cost of its school-sponsored policy, if that aid is in the form of a loan, it means you’re going to be further in debt when you graduate.  Let us know if this is happening to you.

6. What happens if for some reason I don’t finish the academic year? Do I get a refund on my insurance premium?

Many schools treat health insurance premiums just like they do tuition payments, i.e., if you leave school after the first few weeks or the first month, you do not receive a refund.  Other schools are better about this, and allow you to drop the health insurance and get a pro-rata refund.  Be sure to ask about this important feature.  If your school does not allow you to get a pro- rata refund if you leave school, find out whether any tuition insurance you may purchase also covers the cost of health insurance.

7. If I choose to study abroad, will the policy cover me during the term I am abroad?

Your study abroad plans may be a factor to consider when you are choosing a
health insurance plan.  If you plan to study abroad, be sure to check whether a plan provides coverage while you are living abroad.  If such coverage is not provided, you will have to purchase a separate plan for your time away from

8. My school selected me to serve on a committee of students and administrators that is charged with selecting a school-sponsored student health insurance plan.What factors should our committee consider?

New York State Attorney General recently sent a letter to schools that sets forth factors that should be considered when selecting a school-sponsored student health insurance plan.  This letter can serve as a useful guide to students and others serving on committees to choose health insurance plans.  The letter is available at www.NYStudentHealth.com.

¹ For example, many school student health insurance plans exclude coverage for alcohol-related injuries.