Advocating for Quality Student Health Insurance/Benefit Plans

Who Are Your Campus Stakeholders?

Identifying those who utilize health care and counseling services, those who provide such services, and those who facilitate those groups coming together is an essential exercise in determining how any college or university will need to move forward with student health insurance benefits/plans (SHIBPs).

Students

When evaluating student needs campuses can reach out to student government, student health advisory boards, and/or conduct on-campus surveys. All these sources serve to generate a picture of the “consumer perspective” for SHIBPs.

Administrators

Depending on departmental role, there will be specific communications targets:

  • Recruitment/Enrollment: If a SHIBP is to be mandatory, it is necessary for these teams to communicate this requirement to potential and incoming students and parents. It may even prove to be a benefit if a large portion of the student body needs such benefits.
  • Student Retention: SHIBPs can help reduce the number of students who struggle with managing their health care needs, affording health care expenses, and maintaining course loads, and meeting academic requirements.
  • Student Health Teams: As the “first line” providers for many students, knowing the strengths and limitations of on-campus resources will determine both the scope and breadth of what SHIBPs can provide.
  • Local Health Care System: Providers in the surrounding community may or may not contract with a selected carrier for a SHIBP. Other times, the college or university may be the dominant provider in the area. Network considerations for both scenarios are important in creating an effective SHIP with suitable accessibility for the greatest number of students. Self-funding may help navigate challenging situations such as remote locations or small populations that typically have limited options within certain established carrier networks.
  • Risk Management Team: Ideal SHIBPs will address the legalities and liabilities campuses face in providing students with access to quality care. Mental health coverage, for example, continues to be a growing area of concern and a campus with limited on-campus resources may need to consider scenarios that allow off-campus providers and specialists to “bill” the SHIBP, rather than the student. Some campuses may choose to “pre-fund” counseling services on campus—which removes barriers to care associated with privacy or worries about services showing up on insurance billing and benefits statements. These approaches can also be effective with other off-campus specialties like ER services or surgery.

Quality SHIBPs: Key Points

  • Ideally, SHIBPS should be high-quality plans that are affordable to most students.See the ACHA Standards for Student Health Insurance Coverage [pdf] for a set of standards to guide institutions of higher education in the establishment of an appropriate, credible student health insurance program.
  • Minimizing out-of-pocket costs traditionally means higher deductibles and higher co-payments—both of which are difficult for students to manage and can create barriers to care.
  • Having a solid enrollment base makes any plan more sustainable and can be influential in getting the best-possible rates and premiums from major carriers.
  • Colleges and universities may explore whether or not there is a financial advantage to placing graduate students in one plan and undergraduates in another. This may also identify needs for dependent coverage, international coverage, and other services as it pertains to portions of the student population or the whole student body.
  • Electronic health record data is a rich resource for determining utilization of services by age, gender, level of study, and more. Adding anecdotal stories to this data can help create a relatable composite of the “average” student so administrators can make informed decisions regarding SHIBP benefits. 
  • The Affordable Care Act and ACHA both recommend comprehensive plans as opposed to “catastrophic coverage only” plans. Though the latter may be more affordable in many cases, it fails to address one of the key reasons to offer SHIBPs in the first place—the ability to remove the financial burden of health and wellness care that can be a reason a student may not succeed academically.

Evaluating Insurance Requirements for International Students

Some of the key considerations with international students are:

  • Availability or access to health care in their home country. Some international students may come from a universal health care environment. Others may have never had reliable access to affordable care of any kind.
  • Dependent coverage. Many international students have spouses and/or children who will be left without coverage if the SHIP does not allow for dependents to be added (either at student’s own cost or at a subsidized rate).
  • Many SHIBPs will need to consider the inclusion of a rider for international travel to make sure there are no lapses in coverage that would prevent the student or covered dependents from receiving full services for future health care or counseling needs.

SHIBPs in Lieu of Medicaid

Some states may pay for alternative plans for students who qualify for Medicaid. In this scenario, the state pays the cost of the SHIBP for Medicaid-eligible students through a premium assistance program.

Some students may qualify for Medicaid “outright.” Others may need to be emancipated from their parents or guardians to qualify for Medicaid.

  • Not every state has expanded Medicaid enrollment. Check this state-by-state guide to Medicaid expansion, eligibility, enrollment and benefits to see the current status of your state, as this will either greatly reduce or greatly increase the number of students who may be eligible.
  • Student health centers often “augment” Medicaid services rather than serving as primary care providers. Consider what your campus’ relationship with Medicaid will mean if more students must use Medicaid and then compare this to what would be allowed under a SHIBP.
  • Appreciate that students often do not prioritize managing the health care system. So, if Medicaid adds extra layers of complexity, students may not utilize services. The same holds true for SHIBPs. If students find they have difficulty finding covered services, they may avoid it entirely, allowing preventable or easily treatable conditions to escalate or worsen without proper care.
  • In advocating for SHIBPs, one of the main considerations should always be to alleviate the financial burden posed by uncovered health and wellness care costs. It is one of the top causes of financial distress, debt, and personal bankruptcy and can challenge students’ ability to thrive not only in the college environment, but also in the private sector as they begin their careers.