Introduction to Student Health Insurance
Since September of 1989, Massachusetts law, G.L. c.15A, § 18, has required every full-time and part-time student enrolled in an institution of higher learning in Massachusetts to participate in a qualifying student health insurance program or in a health benefit plan with comparable coverage. A part-time student is defined as a student participating in at least 75% of the full-time curriculum.
The Department of Medical Security was initially assigned the responsibility of establishing minimum health benefit standards for students and administering compliance with the student health insurance requirement. In 1996, however, those responsibilities were transferred to the Division of Health Care Finance and Policy (“Division”). The Division’s regulation, 114.6 CMR 3.00, implements the student health requirement and sets forth the minimum benefit levels and required services for a qualifying student health insurance program (“QSHIP”). The regulation also establishes the criteria by which a school may waive a student’s participation in QSHIP upon demonstration of comparable insurance coverage.
The minimum benefit levels and services that are required for student health plans are set forth in the QSHIP regulation. Some of these benefits and services are as follows:
- A Qualifying Student Health Insurance Program must provide reasonably comprehensive coverage of health services, including preventive and primary care, emergency services, hospitalization benefits, ambulatory patient services and mental health services
- Carriers must provide all benefits and services required by the Division of Insurance statutes and regulations
- If a Qualifying Student Health Insurance Program limits benefits per illness or accident, the minimum aggregate indemnity to be paid for all benefits for each physical or mental illness or accident may not be less than $25,000 for the 2006–2007 academic year, and $50,000 for subsequent academic years; the total annual deductibles may not exceed $250 per year.
One of the primary reasons for a mandatory student health insurance program in Massachusetts is to promote students’ access to quality and comprehensive health insurance. As a result, institutions of higher learning will automatically bill full-time and part-time students for individual membership in the health insurance plan sponsored by the colleges or universities. Students must purchase the school sponsored health plan or show proof of comparable coverage in an alternate health plan in order to enroll in Massachusetts colleges and universities.
If a student has an alternate health plan with comparable coverage under his/her parents’ insurance, the student may request a waiver from participating in the college sponsored student health plan. However, for an alternate health plan to be comparable to the qualifying student health plan:
- The plan must provide to the student reasonably comprehensive coverage of health services, including preventive and primary care, emergency services, hospitalization benefits, ambulatory patient services and mental health services throughout the school year
- The services covered under the alternate health plan must be reasonably accessible for all health services to the student in the area where the student attends school.
The burden of proof that the alternate insurance is adequate falls on the student.
Many students have insurance coverage through their parents. However, a health plan through a closed network of providers and accessible only for emergency services is not comparable coverage. Students and parents should be aware of this very important fact.
If you have any questions regarding the student health insurance program, please call the Division of Health Care Finance and Policy at 617-988-3100 or 800-888-2250.
This information is provided by the Division of Health Care Finance and Policy.