QSHIP Frequently Asked Questions

Massachusetts law requires that students enrolled in a certificate, diploma or degree granting program in a Massachusetts college, university or other institution of higher learning participate in a school-sponsored qualifying student health insurance program (“QSHIP”) or an alternate health plan with comparable coverage. The law is M.G.L. c. 15A, § 18, and the Division of Health Care Finance and Policy has issued student health regulations at 114.6 CMR 3.00.

Which students are required to have health insurance?

The law requires all full-time students and part-time students registered for 75% of a full-time curriculum to have health insurance. The number of quarterly, trimester, or semester credits that constitute a full-time curriculum (or 75% of a full-time curriculum) varies from school to school. Students should check with their school to learn how its administrators determine the credit requirements. The law permits schools to grant a waiver from the QSHIP plan if the student demonstrates that he or she has comparable coverage under another insurance plan.  

Are students required to have health insurance in order to enroll in Massachusetts colleges and universities?

Yes. Massachusetts institutions of higher education are required either to enroll students required to comply with the QSHIP requirement in the school-sponsored QSHIP plan or to require the student to verify comparable coverage. 

Are students registered for a full-time load of online courses subject to the QSHIP requirement?

No. Currently, any student registered in an online program in Massachusetts, regardless of that student’s state of residency, is not required to participate in the QSHIP plan or an alternate health plan of comparable coverage.

Can students enrolled in credit-granting, short-term courses (defined as no more than 15 days of classes for each semester of 30 days total for the entire school year) waive out of QSHIP?

Yes. The Division is temporarily allowing schools to waive the requirement to purchase student health insurance for students enrolled in short-term courses for the current 2008 – 2009 school year.  The Division is currently reviewing the QSHIP regulation and hope to provide better guidance on this issue for future school years.

For students enrolled in short-term courses that last longer than 15 days per semester or 30 days for the entire school year, please call (800-609-7232) or e-mail (dhcfphelpdesk@state.ma.us) the Division for further guidance.

Are students enrolled in non-degree granting certificate programs (i.e. students receives only a certificate of participation, with no credits granted, for completing a class or program) required to enroll in QSHIP?

No. Students are only required to enroll in QSHIP if they are earning credits in a degree-granting program.

Can students with Commonwealth Care plans waive out of QSHIP?

No. Students who are subject to the QSHIP requirement are not eligible for Commonwealth Care.  Students may obtain health insurance through their parents’ health insurance, health insurance offered by their employer, the school’s QSHIP plan, or enroll in a Commonwealth Choice plan.

Commonwealth Choice offers a wide range of commercial health insurance plans. There are special Young Adults Plans for 18 to 26 year-olds. Please visit the Commonwealth Connector’s website (www.MAhealthconnector.org) for more details.

What makes an insurance carrier a U.S.-based carrier?

A U.S.-based carrier means that the insurance carrier issuing the plan is a U.S. or domestic company, regardless of where the policy is purchased or where the claims are processed.  Carriers outside of the U.S. means foreign or foreign-based insurance companies (i.e., non-domestic or non-U.S. companies), including those companies with satellite offices in the United States. 

Foreign Insurance Companies with U.S. Subsidiaries

Some foreign insurance companies have numerous companies and subsidiaries worldwide.  A foreign carrier may have a U.S. subsidiary, as well as subsidiaries in other countries.  Policies purchased from the U.S. subsidiary qualify for a waiver, but policies purchased from foreign subsidiaries do not qualify for a waiver (unless the “foreign study abroad” exception applies).

Foreign Insurance Companies with U.S. Satellite Offices

Insurance carriers that are based in a foreign country, but have a U.S. satellite office are considered foreign or foreign-based insurance companies.  Their health plans are ineligible for a waiver unless the “foreign study abroad” exception applies.  

How does a student without health insurance enroll in QSHIP?

The school will automatically enroll the student in the QSHIP plan and include the cost of the insurance in the tuition bill.

What health services are covered by a QSHIP plan?

Student health plans are required to provide reasonably comprehensive coverage of health services, including preventive and primary care, emergency services, surgical services hospitalization benefit, ambulatory patient services, and mental health services. QSHIP plans offered by Massachusetts insurance carriers must include all benefits mandated by Massachusetts law.  If the school's QSHIP plan limits benefits per illness or accident, the maximum aggregate indemnity to be paid for all benefits for each physical or mental illness or accident must be at least $50,000 for each year.

Are there limits on co-payments and deductibles?

There are no limits on co-payments. The regulation permits institutions to impose reasonable co-payments and requires that the QSHIP plan to specify the co-pay amount for in network and out-of network office, clinic and hospital visits. However, there is a limit on deductibles. If an institution chooses to impose reasonable deductible, the annual deductible for QSHIP plan may not exceed $250.

Do QSHIP plans cover pre-existing conditions?

A pre-existing condition is any condition which originates, is diagnosed, treated or recommended for treatment within the six months prior to the insured’s effective date under the policy. For QSHIP plans offered by Massachusetts licensed insurance carriers, a pre-existing condition must be covered no later than six months from the coverage effective date. This requirement applies to the QSHIP plans of most schools.

Is a QSHIP plan effective only during the school year?

The student health policies are effective for a one year or 52-week period. For most schools, students are covered from September 1 to August 31. Some schools’ policies, however, are effective from August 1 to July 31. Students should check with their school or the school's QSHIP brochure to confirm the coverage period.

What is required for a student to obtain a waiver from the QSHIP plan for alternative coverage?

The student must submit a waiver application to the school and certify, in writing, that he or she has alternative coverage, the name of the entity offering the plan, the policy number or member identification number, the name of the subscriber or primary enrollee and the relationship of that person to the student, and a statement that the coverage is comparable to the coverage required under a QSHIP plan. The waiver request must be on a form supplied by the institution, and may be submitted electronically.     

What is considered "comparable coverage" necessary to obtain a waiver from the QSHIP plan?

The health plan must provide reasonably comprehensive coverage of health services, including preventive and primary care, emergency services, surgical services hospitalization benefit, ambulatory patient services, and mental health services; and be reasonably accessible to the student in the area where the student attends school. (See section 3.05 (2) of the regulation.)

Is the alternate health insurance plan required to meet all the criteria of a QSHIP plan to be considered "comparable coverage"?

No. The health plan must be reasonably comprehensive, but may have different levels of covered services and co-payments. 

Is a school required to grant a waiver request if a student's alternative health plan meets the conditions for a waiver?

No. Schools may require students to enroll in the school-sponsored QSHIP plan in order to enroll at the institution. 

What types of health insurance plans are not considered comparable coverage?

Schools may not grant a waiver request if the student has coverage through the Uncompensated Care Pool or coverage issued by a foreign insurance carrier. Insurance through a carrier outside the U.S. or from foreign National Health Service programs is comparable only if the student enrolled in Massachusetts college is studying in a foreign country and the foreign insurance plan provides coverage in that location.

Is MassHealth a comparable coverage plan?

Yes. A school may grant a waiver to a student enrolled in MassHealth.

May a school grant a waiver to international students on scholarships (such as the Fulbright Scholarship) with an insurance plan from a U.S based carrier or the US government that does not meet all of the specified requirements for QSHIP plans?

As noted above, the QSHIP regulation does not impose all of the requirements specified for QSHIP plans upon alternate health plans. Schools have discretion to grant a waiver if the coverage is reasonably comprehensive.

Can a Massachusetts student apply for the Health Safety Net?

Low-income students who are eligible and enrolled in their school’s QSHIP plan may apply and be eligible for the Health Safety Net.  These individuals would be eligible for Health Safety Net Secondary which would only pay for medically necessary services at Massachusetts acute hospitals and community health centers that are not covered by their primary insurance.  Students who are eligible but not enrolled in their school’s QSHIP plan (and do not have a waiver from their school) are not eligible for the Health Safety Net.

This information is provided by the Division of Health Care Finance and Policy.