Your family health plan
The Patient Protection and Affordable Care Act of 2010 provides that all individual and group health plans provide dependent coverage for children up to age 26, without regard to whether the child is a student. Nevertheless, if you have a traditional indemnity plan (i.e., one that provides coverage no matter which doctor you choose), then your child should be able to see any doctor near campus, and your insurer should cover a certain percentage of the expenses as set forth in your plan. The situation is more complicated when you have a health maintenance organization (HMO) plan and your child’s college is not nearby. In this case, your child may need to schedule appointments with his or her primary care doctor during school breaks and other visits home. But it may be difficult or impossible for your child to visit his or her primary care doctor in an urgent situation.
If your child isn’t covered under your family health plan because he or she no longer fits the definition of a dependent child, your child may be eligible for coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). This is an individual plan that’s based on the benefits in your group plan. Under COBRA, your child will be eligible for coverage up to 36 months.
The college health plan
The other option is for you to purchase health insurance coverage through your child’s college. Many colleges offer low-cost health plans for students that may even be less expensive than continuing coverage through your existing family plan. These health plans, though not as comprehensive as some policies, are usually enough to get by on, even if your child becomes seriously ill or has a major accident. The reason that these plans are less expensive than your own plan is the cap they place on total benefits paid (e.g., $250,000). Make sure that you know what the maximum benefit is and that you’re comfortable having coverage up to that limit.
The cost and level of coverage of college health plans can vary greatly from one school to the next. Plans are usually designed specifically for each individual college, and the health services available on campus and in the community often determine what coverage the college can offer. State laws may also play a significant role in the cost and level of coverage.
Questions for your college health plan
Because college health plans can vary widely in their coverage, you’ll want to consider the following questions before you sign your child up:
- Is the plan an HMO, or can your child use any health provider?
- What services are offered free or at low cost in the campus health center?
- Is the campus health center open 24 hours? How is it staffed?
- Are emergency-room visits covered in all situations or only in specific situations?
- Does the plan cover your child when he or she is on vacation (e.g., spring break)?
- Does the plan cover your child during the summer?
- Are hospitals in the college area accessible and utilized?
- Does the plan include mental health treatment?
- What pre-existing conditions are excluded?
- Are there deductibles and coinsurance to be paid?
- What is the maximum benefit amount?
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