What Does Student Health Insurance Cover? Terms And Conditions

Student health insurance

Are you preparing to go away to college and are concerned about finding the right health insurance to meet your needs? Did you know that the typical university plan or even being covered under your parent’s health insurance may not provide you with comprehensive coverage? With all the hustle and bustle that accompanies going away to college, it can become easy for something as important as health insurance to get lost in the mix.


However, the truth of the matter is, that having a student health insurance plan that provides you with the complete coverage you may need during your time away is an essential part of your college process. Not only is it a requirement to attend many universities, but it will provide you a safety net to fall back on in case of emergency, and save you money in the long run if any medical bills arise. If you are confused as to what exactly this type of insurance is and what it does, the following breakdown is tailor-made for you.

What Is Student Health Insurance?

Overview


Student health insurance does exactly what its name indicates, in providing full coverage for enrolled college students. Each plan has various set terms and conditions. You may be a bit confused at this point as perhaps you think that you already have coverage through a standard university plan or by way of being dependent on your parent’s insurance.

smiling students

Universities do normally provide basic insurance to students, but the requirements can make it very hard for you to get the comprehensive coverage you need. These standard university policies often cover only the most basic needs and are not applicable to a number of health circumstances, which can leave you in considerable trouble if any major medical difficulties arise. For example, conditions like asthma may not be covered under these standard university offerings, requiring sufferers to find complete student plans.


There are a number of health insurance carriers that will cover you as a student on your parent’s policy. The catch is, most of the time you will need to be between the ages of 19 and 24, and studying at an out-of-state school may negate the coverage entirely.


Additionally, a number of colleges actually require you to have insurance before starting the semester. Even if this is not the case, having insurance that meets your needs in case of emergency or otherwise is necessary to avoid any unwanted steep medical bills down the road. The added incentive of purchasing a student health insurance plan as opposed to a more standardized alternative is the fact that the former is geared towards students specifically, providing more relevant coverage options at an affordable cost.

How It Works


To purchase student health insurance as an undergraduate student, you will need to be enrolled in at least 6 or 9 college credit hours. You must also be under the age of 30. The specific requirements do vary between states so be sure to check for any individual terms and conditions, state-related or otherwise when choosing a particular plan. Premiums are paid either annually or semiannually.

professor teaching happy students

If you are in graduate school, you will also be eligible for coverage, provide you are enrolled on a full-time basis at an accredited institution. You can typically renew your plan even once you have graduated from college, with situations excluded from coverage including pregnancy, dependent coverage, sports-related injuries, mental disorders, pre-existing issues, substance problems, dental, and vision needs.


Another option for student health insurance is to purchase a short-term policy, which usually is in effect anywhere from 1 to 6 months. The plan may last for the full year as well, with premiums to be paid all at once or in segments. This type is usually the most cost-effective student health insurance offering because of its limited time frame.

Additional Considerations


If you plan on studying abroad during your time in college, many plans will not cover you outside of the United States. As such, you would be required to purchase temporary or long-term insurance geared for overseas studies. This depends on how long you would be abroad. However, some student health insurance plans provide coverage even outside of the country, so it is always a good idea to inquire with your provider to see what is included.

One alternative to enrolling in a typical student health insurance plan is to enroll with a Marketplace carrier instead. If you are a dependent individual under the age of 26 and reside in the same state as your parents do, you can be listed on their application. You can be added to the application at the time of Open Enrollment or Special Enrollment, depending on the situation at play. For example, if you were to be dropped from a student health insurance plan against your own volition, you could qualify for the Special Enrollment period.


If you reside in a different state than your parents, you can stay on their insurance provided it allows coverage out of state, or enroll in a plan specific to the state you will be studying in. If enrolling in your own plan, your parents will include you on their application, but note that you do not require health insurance. You will complete your own application noting that the other members of your household do not need insurance. You can still include your family’s income on the insurance application, at which point the costs for both plans could be lowered due to the aggregate income amounts.


If you are a dependent over the age of 26, the same conditions still apply. If you do choose to apply alongside your parents, you may be forced to select an individual plan due to your age. Alternatively, if you are not claimed as a dependent by anyone, you would need to choose your own Marketplace plan. If you live with your parents, you may need to note their income on the application. Otherwise, the applications savings will be relevant to your income only.

The Benefits Of Student Health Insurance


Protect Your Health


Of course, one of the most obvious benefits of student health insurance is to have coverage in the event of unexpected illness or some other medical emergency. As a student specifically, you are prone to more sickness than usual due to the contagious environment of a college campus, the stress and demands of studying and class, and the change of living independently, perhaps for the very first time.

Some of the most typical sicknesses that students deal with are stomach viruses, colds, flu, sleep, and stress-induced illnesses, allergies, and pink eye. Being on a college campus stretches you and grows you as an individual, but it can be stressful at times and wear down your immune system. When dealing with the demands of receiving a college education, the last thing you want to have to worry about is whether you can actually afford to receive quality medical care should you need it.

Be Prepared


Purchasing student health insurance provides an essential safety net for the future. In fact, unforeseen illness is one of the primary causes of family debt. Prepare for your future and that of your family, by purchasing a plan that preserves your health and financial state.


Being uninsured heightens your chance of suffering from more severe sicknesses, due to the simple fact that proper healthcare is not able to be sustained. If you become ill and are uninsured, chances are you will either try to ride it out or receive minimal care so as to not break the bank. This will only make your condition worse.

Avoid Being Penalized


One of the exceptional benefits to student health insurance is the fact that it protects you from potentially being fined for being uninsured. If you, as a student, do not have health insurance, you may be required to pay a fee. Based on current health care laws if you do not have the coverage, you will be obligated to pay a fine on your next tax return.


The fine comes to 2.5% of the total income for a particular household or $695 for each adult. Whichever comes out to be the higher number makes up the ultimate penalty which does increase each year due to inflation. Having student health insurance is a simple way to avoid these difficulties.

What Does It Cover?


Medical Needs


Finally, it is important to understand what exactly is covered under student health insurance plan. For standardized, long-term student health insurance coverage, you are usually able to choose any doctor or hospital you deem necessary in the event of a medical emergency. Coverage comes into effect at once, with injury policy limits usually coming to $100,000 and lifetime insurance at $1 million. Be sure to check with your specific carrier for any variations on these limits, so you know exactly what is covered, including any unique benefits.

Pregnancy is not usually covered, but some plans do not exclude coverage for pregnancies involving specific complications. Costs like inpatient and outpatient surgeries, inpatient prescriptions, intensive care, and hospital expenses are covered. After a period of 1 year, pre-existing issues may be covered as well. You may be able to purchase coverage that includes pregnancy benefits for an added fee, as well as costs for psychiatric, drug, and alcohol rehabilitation care.


For short-term student health insurance policies, you are also at liberty to choose your own doctor and hospital or other healthcare providers. Lifetime coverage limits are usually $1 million, including ambulatory and diagnosis benefits, inpatient and outpatient procedures and treatment, surgery, intensive care, x-rays, and lab costs. Amounts do vary between insurers, so it is always a good idea to check with a specific carrier for exact coverages.

Deductible And Co-Insurance


Deductibles and co-insurance are also required in the case of both long-term and short-term student health insurance policies. For standardized, long-term plans, there is an annual deductible that must be paid out before you can start enjoying your plan’s benefits. If you pay a higher deductible, then your premiums will be lower. In contrast, if your deductible is less, your monthly payments will be higher.


Co-insurance comprises the costs that your policy will allow reimbursement for after the deductible has been satisfied. Usually, the carrier pays 80% of any incurred medical costs, leaving you responsible for 20%. In the case of short-term student health insurance, you must also may your deductible before co-insurance kicks in. After that point, your insurance carrier will either pay 80% or 50% of the incurred costs, leaving you responsible for either 20% or 50% of the rest.

Conclusion


Having a comprehensive student health insurance plan is an essential aspect of receiving your college education. Although overlooked by some, it provides reassurance that your health and medical needs will be met throughout your time at college, giving you one less thing to worry about. The costs and penalties associated with being uninsured will not only needlessly increase your stress level, but prevent you from obtaining the medical care you may require.


When choosing a student health insurance plan, be sure to ask questions, examine related terms and conditions, and make sure the benefits, deductibles, premiums, and co-insurance costs are clearly outlined. In this way, you will be able to choose the policy that best meets your needs for the duration of your college life and beyond.

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