Health insurance Waiver for Students in US (Part 2/2): What are the waiver requirements for university/college sponsored health insurance?

In the previous blog, we talked about certain conditions when students should opt for alternative health insurance plan in place of their university/college sponsored student health insurance plans. In part 2 of the 2 part blog series, Student Cover brings you the various waiver criteria set by universities and colleges in the US for students to get insurance waiver. If you haven’t read part 1 of the blog series, click here to go to part 1.

What are the waiver criteria for university/college sponsored health insurance plans?

Each university or college in the US has its own set of waiver requirements for those students who wish to opt out of their sponsored student health insurance plans and purchase a plan from outside. We have listed some common waiver requirements sought by most universities.

There are certain waiver requirements that are universal in nature and are applicable in all US universities while there are others which are specific in nature and applicable in specific universities.
Universal Waiver requirements:

1. Maximum benefit coverage(sum insured) should match or exceed the stipulated amount – Any college or university that offers its own sponsored plan expects a student to purchase a plan whose benefits are either equal to or better than that offered by it. In another scenario, even if the University is not offering its own sponsored plan, then also it expects students to enroll in an alternative plan offering a certain coverage limit.

E.g. If a University sponsored plan has a sum insured of $100,000 or if it has mentioned a certain coverage limit for an alternative plan, a student can only purchase those plans whose
coverage is either equal to or more than $100,000 or the stipulated amount.

2. Should cover repatriation and medical evacuation costs – An alternative plan should provide sufficient coverage for medical evacuation of a student if he or she falls seriously ill and needs to get treatment in his or her home country. In the unfortunate event of a student’s death, it should also have provision to pay for the cost of repatriating the student’s mortal remains back to his or her home country.

3. Cost- sharing – As mentioned in previous blog of this series, health insurance plans follow a cost sharing model wherein the insured has to bear a portion of the cost of medical treatment in terms of “Deductibles, Co-pay and Co-insurance. However, this cost sharing has a limit called “Out-of-Pocket maximum” which entails that an insured person does not have to pay any expense when his expenditure through deductibles, co-pay and co-insurance reaches a certain amount limit. Beyond that, the health insurance provider has to bear 100% of the cost of treatment during a plan period. An alternate health insurance plan’s “out-of-pocket maximum” limit should be equal to or less than that set by the University.

4. Provide continuous coverage without exception – Universities and colleges also require the alternative health insurance plan to provide continuous health coverage to the student without any exception. They must cover the health cost even if the student falls sick during including intervening recess periods or holidays. It also includes the period between semesters if it falls in the plan period. However, geographic limitation of coverage for treatment in places not under sovereign jurisdiction of US government is considered.

5. Should cover Preventive Healthcare – All health insurance providers are required to provide coverage for those treatments and counseling which fall under the definition of preventive healthcare. These may include
de-addiction counseling, certain preventive care therapies etc. Most good health insurance plans such as Student Cover’s health plans (SC Basic, SC Essential, SC Plus and SC Elite) provide 100% co-insurance for preventive care.

6. Should cover both In-Patient and Out-Patient treatment – For an alternative health insurance plan to be accepted for waiver, it should cover both inpatient (when the patient is admitted in the hospital) and outpatient (when a patient is not admitted) treatment costs. Any health insurance plan that does not provide outpatient treatment cover will not be considered for waiver by any university or college in the US.

University/College specific waiver requirements:

1. Plan should be PPACA compliant – Most university and college sponsored plans are ACA compliant which means that they meet all requirements of Patient Protection and Affordable Care Act, 2010 (also known as Affordable Care Act or Obamacare Act). Therefore, students seeking waiver from the sponsored plan must purchase a plan which is also ACA compliant.

2. Plan must be from government or sponsoring agency – Those students who have come to study in the US as sponsored student under a government or non-government program are eligible for waiver if their student health insurance is provided by the government or sponsoring agency.

3. Plan must be a US based company plan – In some cases, Universities demand that the alternative health insurance plan must be from a U.S. based company. Any plan purchased from a non-US based company, no matter how good it is, does not qualify for Insurance fee waiver.

4. Plan must be employer based insurance – If a student studying in the US University is employed by a U.S. based employer and enjoys coverage under the employee health insurance plan, he or she is might be eligible for waiver.

5. Plan must be family health plan – Those students who parents or spouse are currently employed in the US by a US based employer and whose employee health insurance covers their health expenses as well are also eligible for cover can get waiver.

Let’s Wrap Up!

Universities and colleges in the US require students opting for individual plan to meet certain waiver conditions or requirements in order to get waiver from university/college sponsored plans. Some of these waiver conditions are universally applicable in all universities and colleges while others are more specific. A student is advised to go through the waiver requirement of his or her university/college before purchasing any private health insurance plan.

Disclaimer: The blog is based on the data and research done by the blogger in his/her personal capacity. Readers are advised to exercise their own discretion while purchasing any insurance policy.