October 3, 2011


Our guest asks:

My school requires that my health insurance meet these requirements: 

• Minimum Requirement Coverage for at least 80% of CC* for both emergency as well as non-emergency (e.g., routine or specialty care), provided in the Chicago area.  
• Lifetime Maximum Coverage $1,000,000  
• Coverage for Pre-existing conditions 80% of CC*  
• Inpatient Hospital Benefits (including labs, x-rays, and misc. expenses) 80% of CC*  
• Emergency Room Visits and Treatment 80% of CC*  
• Outpatient Benefits (e.g. Physician office visits, labs, Physical Therapy, radiology, etc.) 80% of CC*  
• Outpatient Mental Health Benefits 80% of CC* up to 25 visits/year  
• Inpatient Mental Health Benefits 80% of CC* up to 30 days/year  
• Prescription Drug coverage of at least $1,500/year
• Ambulance coverage 80% of CC*  
• Access to Primary Care Physician/Provider in the location you will be studying
• Medical evacuation and repatriation coverage (in the event that you are traveling and need to be transferred to another location) 

Can you help me change my insurance to meet these requirements?
OnlineAdviser responds:

Effective for the school year that began this September 2011, none of the nation’s commercial major medical insurance plans that are available to individuals meet the specific requirements of America’s colleges and universities that issue such directives. Most students who previously enrolled in plans like those listed on the insurance exchange have been required to enroll in the more expensive school plan rather than purchase a less expensive plan.

One sticking point is that major medical insurance does not cover pre-existing conditions. Since most students do not have pre-existing medical conditions, it is a moot point for most policyholders but colleges and universities require this coverage in student plans. 

The underlying issue is that student insurance is substantially different in design, intent and limits than commercial major medical insurance. Major medical insurance covers the potential catastrophic expenses and excludes known or routine expenses whereas student insurance focuses more on the more common and routine expenses and has lower limits for catastrophic expenses. Unfortunately the two types of insurance are not interchangeable and you may be required to select the school-sponsored plan.

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