Student Health Insurance Plan - FAQ
Updated Aug. 1, 2016
The issue of student health insurance has garnered much attention in recent years. Other colleges and universities, like us, have moved toward insurance requirements because a growing concern exists about students’ inability to obtain basic health care and the increase in medical-related student drop-out rates. This led the University’s Board of Trustees to approve that insurance coverage be required as a non-academic condition of enrollment at the College of Law. Health insurance provides protection for many unexpected illnesses and injuries that can interrupt the student educational experience. In our experience, students without insurance often defer or neglect their health and health care because of the expense. No student should have to decide between continuing his or her education and paying a medical bill. Although the College of Law does not offer Student Health Insurance, information on the ACA Marketplace and outside plans can be found below.
This Frequently Asked Questions document provides some details about the Domestic, International and Study Abroad plan requirements.
Domestic Insurance Requirements
What is the requirement on student insurance?
The following students are required to have health insurance:
a. International students who hold F or J visas;
b. Students enrolled in any of the following programs:
(i) Full-time J.D. or J.D. dual-degree program;
(ii) Part-time J.D. or J.D. dual-degree program; (iii) LL.M. in International Law;
(iv) Visiting or transient students; or
(v) Any Stetson Law sponsored study-abroad program.
When does this requirement take effect?
The decision to require that students have health insurance coverage became effective with the Fall 2009 semester. Mandatory international insurance was already required for study-abroad programs, and that requirement remained as well.
What happens if I am a Stetson student going elsewhere for a domestic exchange program like the University of New Hampshire School of Law Intellectual Property program?
You remain actively enrolled at Stetson even while attending a domestic exchange program at another school. Therefore, you are still subject to the mandatory insurance.
Will I be able to obtain financial aid to pay for mandatory insurance?
Yes. You may have student loan eligibility under the Stafford or Grad PLUS Loan to pay for coverage. Please contact the Student Financial Planning office firstname.lastname@example.org for help.
As with most colleges, all students enrolled at Stetson University are expected to have adequate health insurance to cover them while attending the university.
You are required to have medical insurance in effect for you (J-1 Visa) for the duration of your program. Because International Students are not US citizens, they are not eligible for insurance through the Marketplace. Outside plans may be available or International Students many have their own insurance but either must meet or exceed the U.S. Department of State’s insurance guidelines shown below. Proof of insurance must be provided to the Office of International Programs.
USCIS Insurance Levels:
- Medical benefits of at least $100,000 per accident or illness;
- Repatriation of remains in the amount of $25,000
- Expenses associated with medical evacuation of the exchange visitor to his or her home country in the amount of $50,000; and
- a deductible not to exceed $500 per accident or illness.
Domestic Students (U.S. Citizens/Non-International students):
New insurance mandates implemented a few years ago allow students to remain on their parent’s insurance until age 26 (even if married). Per the Affordable Care Act (ACA), starting in 2014, the ACA mandates require that most people have insurance, and some could incur a penalty for not having coverage. For general information about the Affordable Care Act, go to the Government’s ACA website: www.healthcare.gov . (See “Get Answers” Tab at the top of the page.)
Searching for Plans / ACA (Affordable Care Act) Insurance Marketplace Exchange:
If you are not currently covered under your parent’s plan or another health plan; or you have currently lost coverage through no fault of your own (such as your current policy ending and no longer available); you may want to search for plans through the ACA Insurance Marketplace (also known as the ‘Exchange’). This is a key feature of the ACA. The Marketplace allows you to shop online to search for the right health insurance plan for you. You can’t be denied or charged more due to a pre-existing condition.
The general Open Enrollment dates for the ACA Marketplace are: November 1 through January 31. Anyone can search for health plans during this timeframe.
Enrollment Date Exceptions: You may still be able to obtain coverage through the Marketplace before or after those dates if you currently have no health insurance due to certain circumstances (such as losing coverage through no fault of your own; current policy ending, dropped from parent’s coverage, etc.).
This is explained at the ACA/Healthcare.gov website.
Here is the link and contact information for the ACA Insurance Marketplace Exchange:
www.healthcare.gov or contact ACA Exchange:
Available 24/7: 1-800-318-2596 / TTY: 1-855-889-4325
Searching for Plans Outside of the Marketplace:
You may also search for `Individual Health coverage plans’ by searching the Internet or specific health insurance company websites, such as Blue Cross/Blue Shield, United Healthcare, Aetna, Cigna, Humana and others. There are also companies set up to search plans for you that are not a part of the ACA Exchange and can provide quotes for Individual plans and Short-Term plans even before or after the Exchange open enrollment. Some Individual, catastrophic or Short-term health plans do not have all of the Affordable Care Act Benefit mandates (such as unlimited coverage and no pre-existing condition exclusion). Per the ACA.gov definitions, they may or may not be considered as ‘minimum essential coverage’.
To see what type of plans the Government (IRS) considers that qualify as Minimum Essential Coverage, please go to this Link*:
Following are a few types of insurance plans they list as “qualifying” minimum essential plans (there are more, but these are the most common ones, and are summarized)*:
- Plans you purchase from the Insurance ACA Marketplace (aka Online Healthcare.com Exchange)
- Individual Health Insurance you purchase directly from an insurance company
- Catastrophic Plans
- Children’s Health Ins Program (CHIP)
- Most types of TRICARE coverage
- Most Medicaid coverage
The irs.gov link http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Minimum-Essential-Coverage also lists what is NOT considered as Minimum Essential Coverage.
*It is up to each individual to determine what plan is right for them and if it is considered as Minimum Essential Coverage.
When searching outside of the Marketplace, below are a few companies that can provide Short-Term/Individual Health Plans. There are many plans available to search through. These are only a couple examples for reference*:
United Healthcare One/ Short Term Plans: Link: https://www.uhone.com/insurance/short-term
E-Health Short-Term Plan Search Website: Link: https://www.ehealthinsurance.com/
*Note: Finding the right plan varies from person to person depending upon their needs, so it’s important to check the benefits and exclusions of each plan to see if it is right for you.
Stetson University does not endorse or recommend any particular insurance company, search website, or health plan. The information provided in this document is for assistance and reference purposes only and includes no guarantee of accuracy.
Whether you search for plans within the ACA Marketplace, or via the Internet for Individual or Short-Term plans; when deciding upon a plan, it is recommended that you review the proposed plan very carefully to include, but not limited to reviewing the following important items:
- Overall Max Coverage Amount (Limit): Per each Accident/Illness? Per Year? No Limits?
- Check for any coverage sub-limits on specific procedures or services
- In-Network medical providers and doctors in your area: Most insurance companies cover more of the cost if you use their ‘In-Network’ or “Preferred” doctors and medical providers. And some will not provide coverage if you go to a medical provider or doctor ‘outside’ of their provider network. Check the plan to see what the rule is for this.
Check out their Preferred `Provider Network’ to make sure there are sufficient hospitals, urgent care, Radiologists, labs, and specialists (such as Orthos, ENT’s, etc) in the area you will be accessing them. This is usually done by zipcode. Stetson University’s Zipcode to search for providers is: 32720 Many are nationwide, so you may want to check the listing in your home area as well.
- Health Services on Campus: You may want to check with the campus Health Services to see if they accept the plan you are considering in case you need to or wish to seek treatment there.
- Deductibles: The amount you will pay out of pocket for medical costs before the insurance company will begin paying their share of medical bills. (often it is an annual deductible, but some medical services may have a ‘per-visit’ or ‘per illness/accident’ deductible.
- Co-Insurance Coverage: The amount or percentage of your medical bills that the insurance company will pay for. (Example: 80%/20% Co-Ins = Insurance Co pays 80%; You pay 20%)
- Usually the Insurance Company starts paying medical bills at the Co-Insurance coverage % amount after you have met the plan deductible.
- Co-Pays: Some Plans will have a set Co-Pay Amount such as for doctor visits or for prescriptions which you pay to the doctor/pharmacy.
- The Copay for a doctor visit is usually the only amount you pay for that visit (unless extra medical supplies or procedures are done).
- Copay Amounts for Prescriptions can vary depending upon if the Rx is Generic, Brand, or Non-Preferred.
- Prescription Coverage: Check to see if Rx’s are covered at a % or with a set Co-Pay.
- Exclusions: Read through the insurance company’s exclusions to find out what is not covered.
- Pre-Existing Health Condition Exclusion (is there one listed in the exclusions?) – This exclusion means that if you had any health issues prior to signing up for the plan; they will not pay any medical bills for those pre-existing health issues for the timeframe they note in the pre-existing exclusion
(can be anywhere from 6 months or 1 - 5 yrs.)- Most Short-Term plans have pre-existing exclusions.
- Note on ER Visits: Many insurance companies will not pay for medical costs at the Emergency Room if you seek treatment there that is NOT considered as a “Medical Emergency”. It is often better to go to an Urgent Care/Walk-In clinic if your issue is not a true emergency.
- Medical Emergency: Check the health plan to see what their definition is of a “Medical Emergency”. Also, find out what Urgent Care/Walk-In Clinics are available in the Provider Network in your area.
Study-Abroad Insurance Requirements
When does this requirement take effect?
This requirement is already in place and is not a new requirement.
Why does the College require additional insurance for study-abroad programs?
Many domestic insurance plans either do not cover international travel, or are difficult to use in emergency conditions outside the United States. Having a comprehensive international health insurance program provides protection for the unexpected illnesses and injuries that can interrupt the student international educational experience.
Is the coverage optional for any study-abroad participants?
No. It is mandatory for all students who participate in a Stetson Law study-abroad program. This includes all summer abroad programs sponsored by the College of Law, the Autumn in London program, and all exchange programs sponsored by the College of Law. Students attending study-abroad programs sponsored by the main campus in Deland or other colleges or universities are only subject to that institution’s requirements.
Doesn’t this coverage duplicate my domestic health insurance?
No. The policy for study-abroad is an international policy specifically selected to provide an adequate level of coverage in the country where the program occurs. The domestic insurance described above provides for coverage within the United States.
I am attending only a study-abroad program this summer. Does this mean I need to have both domestic and international insurance?
It depends. Most domestic policies are typically paid on an annual premium, which means you will already have summer coverage. You would need to check if you can get coverage for a shorter period of time but if allowed, that could result in a gap in your insurance and possibly cause issues during the next open enrollment. The same could be true for students attending the Autumn in London Program. We encourage you not to cancel domestic insurance. If you did opt to not have domestic coverage while abroad and then are diagnosed with a serious health condition, a gap in domestic coverage could result in a potential delay in coverage availability or even no coverage once returned.
Disclaimer: The information contained in these materials is intended as an informational update as we continue through the implementation of student health insurance at the College of Law. This document is subject to change as we obtain further information on the process. It is not intended to provide a complete analysis or discussion of each topic. In addition, if any conflict exists between this document and the final plan terms, the final plan terms are controlling. The application of the insurance requirement to a particular situation may also depend upon an investigation of specific facts and circumstances than can be provided in this format.
Issued May 29, 2009, revised July 9, 2009, August 10, 2009, January 12, 2010, March 15, 2010, July 22, 2010, January 5, 2011, July 25, 2011, July 13, 2012, July30, 2013, August 3, 2014, August 1, 2015, August 2016