Considerations for Implementing
Student Health Insurance/Benefits Plans

What Is the Health Care Landscape Like on Your Campus?

  • Every institution will face different needs and challenges depending on a variety of factors. These include geographic location, availability and proximity to community health care resources, size of student population being served, demographics of student population, and risk management guidelines.
  • On campuses that are more remote, rural, or self-contained, students may be more dependent on the college or university for their health care and counseling needs. Such campuses may also be one of only a very few available resources for students to obtain health insurance. For some students, campus-provided or campus-sponsored plans may be their only opportunity to secure health insurance. 
  • For campuses in more metropolitan or urban environments, students are likely to have more options for accessing health care and counseling services and will therefore be less reliant on campus-provided or campus-sponsored health insurance plans.
  • Costs, premiums, benefits, and co-payments can vary widely depending on the size of the student population as well as available providers and resources in the area that are contracted with a particular plan.

Potential Challenges on Smaller Campuses

While no two campuses are exactly alike, smaller campuses are more likely to face the following scenarios:

  • There may be a lack of comprehensive care available on campus, which requires forging partnerships with resources within the neighboring community.
  • If the surrounding community is also small, isolated, or remote, it may not have the capacity to serve the entire student body. As such, providers may choose not to contract with the SHIBP carrier— including if that plan is self-funded by the college or university.
  • Smaller campuses may need to be innovative in filling gaps in certain aspects of care. Telemedicine, nursing hotlines, and counseling via phone or chat are solutions that can be effective. It is important to discuss any such resources with carriers as part of any decision-making process.
  • If there are no suitable solutions for a particular need—for example, vision, dental, mental health, or in-patient medical facilities—smaller campuses may need to cultivate those resources on campus. This can add both start up and ongoing expenses to the overall campus health department’s budget.
  • Large insurance carriers may not have coverage in a specific area. This may indicate a need for smaller colleges and universities to consider self-funded plans as a means to providing students with coverage that meets ACA minimum requirements. 

Potential Challenges on Larger Campuses

Though larger campuses typically enjoy greater accessibility to community-based health care and mental health resources, there are a few scenarios that can be difficult to manage when it comes to providing student health insurance/benefits plans:

  • If students account for the majority of the population for an area, even local resources may lack capacity to serve such high numbers of people.
  • Community resources may already be committed or contractually obligated to certain carriers—which may limit options for SHIBPs.
  • Students may incorrectly assume that having a wide variety of health care options within the community means they can access any provider they wish. Campus health teams will have to educate students on the limitations and requirements of their specific SHIBP to avoid uncovered expenses.
  • Self-funded student insurance plans, while very customizable, may prove to be complicated and expensive to administer in house.

Special Concerns for International Students

  • Campuses of all sizes must be aware of their international students’ needs when researching, selecting, and implementing student health insurance/benefits plans.
  • International students often come from destinations where universal health care is in place and may be unaware of the need to have health insurance in place to avoid paying expensive out-of-pocket costs for medical and mental health care services.
  • International students may also be under-informed about the limitations of travel health insurance plans and the extent to which they may access or be denied care beyond certain travel scenarios. Campuses need to clearly communicate the differences between SHBIPs and travel health plans.
  • Navigating the health insurance landscape may be challenging for international students with no previous exposure to the U.S. managed-health care system. Campus health teams may need to provide staff and guidance for assisting students.
  • Language barriers may present unique challenges for certain students, particularly when seeking services off campus and/or with community-based providers. Knowing the number or percentage of students requiring translation or similar services should be discussed with carriers and/or on-campus administrative teams for any SHIBP.
  • International students are typically older, may have dependents, and/or may need options for out-of-network coverage to avoid “lapse in coverage” scenarios when traveling back home.

Enrollment and Plan Costs

  • All SHIBPs rely upon a core base to make plans economically viable. Often, this means there must be requirements in place to ensure adequate enrollment across the student population.
  • Common enrollment requirements include:
    • Mandatory enrollment for all students living in campus housing.
    • Mandatory enrollment for all full-time undergraduate students.
    • Voluntary enrollment for graduate students.
    • Voluntary enrollment for commuter or part-time students.
  • Offering coverage for dependents can greatly increase plan costs and premiums for all enrollees. This element should be carefully evaluated prior to contracting with carriers.
  • A waiver model may be a preferred option for those students who may be insured under their parents’ plans. This model allows the students to maintain their existing coverage and benefits. It is important for campus teams to provide sufficient resources for students and parents to compare SHIBPs against individual or employer-based plans to be certain the student is receiving the best level of health care access within proximity to the campus.
  • Requiring students to enroll in SHIBPs may be one of the most effective ways for students to avoid incurring debt associated with health care and mental health services. It may also help improve willingness to seek care and reduce the incidence of untreated and/or undiagnosed medical and mental health problems.
  • Student fee-based services such as a recreation center, peer counseling, campus dining nutritional standards, and similar initiatives that improve health and wellness on campus should be communicated to carriers. Often, the presence of these programs can reduce plan costs and premiums for all enrollees.


ACHA Guidelines: Standards for Student Health Insurance/Benefits Coverage [pdf]

ACHA Student Health Insurance/Benefits Plans Coalition

ACHA: Do You Know Why Student Health Insurance Matters? [pdf]