Check your col­lege kid’s health in­sur­ance

The Denver Post - - LIFE & CULTURE - By Elis­a­beth Leamy Is the plan a “self-in­sured” plan or is it run by an in­sur­ance com­pany? Is the plan ef­fec­tive for 12 months or just the school year? Is the cam­pus clinic a small, stu­dent-only fa­cil­ity or a large, univer­sity teach­ing hos­pi­tal? Does t

If you have a kid in col­lege, you may be dou­ble-pay­ing for their health care cov­er­age. Most four-year univer­si­ties of­fer a stu­dent health in­sur­ance plan, and many au­to­mat­i­cally en­roll stu­dents in the plan. When he was at­tor­ney gen­eral of New York, An­drew M. Cuomo warned 300 col­leges that they needed to “clearly and con­spic­u­ously dis­close” this manda­tory cov­er­age and item­ize the cost. Stu­dent health in­sur­ance plan prices vary dras­ti­cally, from $1,750 a year at Amer­i­can Univer­sity, for ex­am­ple, to $4,103 a year at Ge­orge Wash­ing­ton Univer­sity.

Ei­ther way, that’s a siz­able chunk of money to pay if your child is al­ready cov­ered by your own plan. And more off­spring than ever are, be­cause of a pro­vi­sion in the Af­ford­able Care Act that al­lows chil­dren to stay on their par­ents’ plan un­til their 26th birth­day. (Pro­posed Repub­li­can bills to re­place the ACA keep this pro­vi­sion in­tact.) In fact, par­ents may be pay­ing a col­lec­tive to­tal of $1.2 bil­lion in re­dun­dant health in­sur­ance costs, ac­cord­ing to a study by

EEKey­bridge Re­search.

So you should def­i­nitely find out whether your child’s col­lege is one of those that au­to­mat­i­cally en­rolls stu­dents in its health plan. But be­fore you rush to opt out, keep in mind that there are pros and cons to both choices — col­lege health plans and par­ent health plans. Here are the main things to con­sider in mak­ing the de­ci­sion.

Col­lege health plans ad­min­is­tered by in­sur­ance com­pa­nies have to meet min­i­mum cov­er­age stan­dards set by the ACA. “Selfin­sured” plans, in which col­leges pay claims di­rectly, are not re­quired to meet those stan­dards, al­though some still do.

Many col­lege health plans are ef­fec­tive 12 months a year. If the pol­icy is in ef­fect only nine months a year, you may need a short-term health plan or cat­a­strophic cov­er­age (which cov­ers peo­ple in the event of a ma­jor ac­ci­dent or ill­ness) to fill the gap.

Some cam­pus clin­ics are oneor two-room fa­cil­i­ties with staff pre­pared only to treat com­mon ail­ments, such as the flu or uri­nary tract in­fec­tions. Oth­ers are world-class hos­pi­tals with ev­ery pos­si­ble kind of med­i­cal prac­tice at­tached to them.

Some stu­dent plans do al­low ac­cess to hos­pi­tals near the univer­sity. If not, the cam­pus clinic may not be suf­fi­cient if the stu­dent has com­pli­cated ex­ist­ing health prob­lems, gets in a ma­jor ac­ci­dent or con­tracts a se­ri­ous ill­ness.

If the plan al­lows stu­dents to visit off-cam­pus doc­tors and hos­pi­tals, is there a mileage limit? Some plans cover only vis­its near the school, a prob­lem for stu­dents who are at­tend­ing col­lege far from home and may need med­i­cal care while vis­it­ing their par­ents. Or it could make it dif­fi­cult to find providers who are in-net­work while a stu­dent is at home.

If it is tied into the to­tal cost of the stu­dent’s ed­u­ca­tion, fi­nan­cial aid or stu­dent loans will prob­a­bly cover it, which could be help­ful if cash is tight.

Some HMOs and PPOs have net­works of doc­tors and hos­pi­tals in only one state. Oth­ers are much broader and cover mul­ti­ple states. Does the par­ent’s plan of­fer in-net­work care in the same state as the col­lege?

Most of­ten they do not. This means stu­dents must pay for care out-of-pocket and then sub­mit a claim to the par­ent’s in­sur­ance com­pany. The pa­per­work can be a has­sle and many claims are re­jected.

If you are lucky enough that the cam­pus clinic does take your in­sur­ance, find out if it is con­sid­ered “in-net­work” or “out-ofnet­work.” Of­ten pa­tients have to pay 10 to 20 per­cent of their med­i­cal bills for in-net­work cov­er­age but 30 to 40 per­cent for out-of-net­work providers. If the col­lege is in a large ur­ban area with lots of nearby doc­tors and hos­pi­tals, maybe skip­ping the cam­pus health clinic will not be a bur­den. But if the col­lege is in a small town or ru­ral area, get­ting out­side care could be chal­leng­ing.

Many HMO-style plans and some PPO plans re­quire a re­fer­ral from your pri­mary care doc­tor be­fore you see a spe­cial­ist. If there are no in-net­work doc­tors near the col­lege, the stu­dent could have to co­or­di­nate with a home­town doc­tor, which can be a pain.

This is com­mon and means that if there is more than one child in the fam­ily, each ad­di­tional child is cov­ered by the par­ent’s plan free. In this case, switch­ing to the cam­pus health plan is def­i­nitely an ad­di­tional cost.

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