AICUM - FAQ about College Student Health Insurance

A QSHIP is a health insurance plan that is sponsored by a college or university and one that meets a specific level of benefits as required by the Commonwealth of Massachusetts. Since 1989, all full-time and part-time students enrolled in an institution of higher learning in Massachusetts have been required to participate in a QSHIP or in a health insurance plan with comparable coverage.

Why was the QSHIP developed in Massachusetts?

The QSHIP was established to promote students’ access to quality and comprehensive health insurance. Many insurance plans do not provide coverage for dependents who are full-time students over the age of 19 and the QSHIP allows students to have access to an affordable health insurance alternative. International students have access to the same coverage of health benefits as domestic students under the QSHIP. Requiring participation in a QSHIP or comparable alternative plan also ensures that students will have health services available in close proximity to their school.

If I am a part-time student, do I have to enroll?

No, but your status depends on the number of credits you are enrolled in. A part-time student is defined as a student participating in at least 75% of the full-time curriculum. The number of quarterly, trimester, or semester credits that represents this 75% of full-time curriculum varies from school to school. Students should confirm how their school determines credit requirements before assuming they are not considered part-time by the QSHIP. If the student is considered part-time and has comparable coverage under another insurance plan, he or she would be allowed to waive from the QSHIP.

I already have health insurance; do I have to be enrolled in the school insurance?

No. Students who are covered under a health insurance plan of comparable coverage, can waive the school’s plan. In order to waive, students must submit a waiver form to the school and certify, that they are enrolled in another plan. The following information is required for proof of comparable coverage: name of the insurance company, policy number or member identification number, name of the subscriber or primary enrollee and the relationship of that person to the student, and a statement that their current insurance is comparable to the coverage required under QSHIP standards. The waiver form must be a document supplied by the school. Some schools use a printed waiver form, but many use an online waiver form. This waiver process must be done on an annual basis.

I have insurance through my parents’ plan, how do I know if that is comparable coverage?

An alternate plan must provide the following services to a student throughout the school year:

Reasonably comprehensive coverage of health services, including preventive and primary care, emergency services, surgical services, hospitalization benefits, ambulatory patient services, and mental health services; and
Services must be reasonably accessible and in close proximity to the school location.

It is important to note that a health plan that only has a closed network of providers (i.e., no national network) and/or only provides access for emergency services when a student is out-of-area is not considered comparable coverage.

As a parent, why should I look at my insurance coverage?

It is the responsibility of the student and/or parent(s) to determine if their insurance coverage is comparable. These minimum health benefit standards for students were established by the Massachusetts Division of Health Care Finance and Policy. This Division, in cooperation with the institutions of higher learning in Massachusetts is responsible for administering compliance with the student health insurance requirement.

What if I don’t have health insurance or my coverage is not comparable, how do I enroll in school insurance plan?

Schools will automatically enroll students in the school sponsored plan and include the cost of the insurance in the tuition bill, unless the student shows proof of comparable coverage in an alternate health plan.

What is the percentage of students who enroll in the school sponsored plan?

At Massachusetts institutions, the number of students enrolled in the school sponsored plan is 30-35%.

Do I have to fill out a waiver form annually?

Yes. Recognizing that health insurance coverage may change, schools must require students with comparable coverage to complete a waiver form at least once a year, as part of the school’s usual registration process.

Can international students waive out of the school insurance?

Yes. International students can waive out of the school insurance if they are enrolled in a comparable insurance plan provided by a U.S.-based insurance company. Schools may not grant a waiver request if the student has coverage issued by a non-U.S.-based insurance carrier. Insurance coverage through a carrier outside the U.S. or from foreign National Health Service programs can be waived only if the student is studying in a foreign country and the foreign insurance plan provides coverage in that location.

I am enrolled in MassHealth, can I waive out of the insurance?

Yes. MassHealth is considered comparable coverage and the school will grant a waiver to students enrolled in the MassHealth plan. However, note that MassHealth generally terminates a student’s coverage when the student turns 19.

I use the Free Care Uncompensated Care Pool (UCP), can I waive out of the Insurance?

No. Free Care is not considered a comparable plan. Students cannot waive out of the school insurance plan if the only other plan they are enrolled in is Free Care UCP. According to QSHIP, the Massachusetts Uncompensated Care Pool only provides supplemental and not comparable coverage to the school plan. A low-income student can apply for UCP and be able to have eligible co-pays and deductibles and medically necessary services covered that are not covered by the student’s health plan.

Will any of the QSHIP regulations change for next year?

Yes. Starting in the 2007-2008 academic year, documentation of insurance will be required in order to waive participation in the QSHIP. This new requirement states that, in addition to a written waiver request (which can be done online); an institution must either obtain documentation of the student's insurance status or otherwise verify the student’s health insurance coverage. This documentation includes, but is not limited to, a copy of the student's ID card or insurance policy. Procedures are being developed to assist schools with the implementation of this new requirement. Koster Insurance is working with AICUM to review and modify this new documentation requirement, due to the additional administrative responsibilities that will be required.

As an institution, what is the requirement for data reporting to the Division?

On June 15, 2009, the Massachusetts Division of Health Care Finance and Policy (Division) released adopted amendments to the Student Health Insurance Program regulation 114.6 CMR 3.00 (formerly called ‘QSHIP). The amendments make various changes to Student Health Program administrative and reporting requirements, which will have an impact on Massachusetts Student Health Insurance plans immediately.

The full regulations & updates can be found on the Division of Healthcare Finance & Policy website at: http://mass.gov/dhcfp/. Additionally, a complete description of the adopted regulations was sent to the main administrative contact at each School by the Division in mid-June.

The major points that will have an immediate impact on the administration of Student Health Insurance Plans include:

Requirement to consider the termination from another health benefit plan, including MassHealth and Commonwealth Care, a qualifying event, and prorate premiums, based on the month of enrollment in the Student Health Program, for students whose coverage under another health benefit plan has been terminated.
Enhanced data submission requirements to report health plan metrics to the Division, including such categories as: rate of claim denial, number of grievances, plan administrative costs, plan medical costs and medical loss ratio.
Revised reporting requirements calling for schools to submit additional health plan benefit description information to the Division.
Removal of the requirement for schools to obtain documentation of comparable coverage from students as part of the waiver process.
Revised student communication requirements regarding coverage & the waiver process to require that:

A Student Health Program’s Evidence of Coverage (EOC) and related health benefit information be posted to the Program’s website.
Students are notified of the website’s availability at the same time registration materials become available, but no less than 30 days in advance of the registration deadline.
A staff member be designated as the student resource for the school’s Student Health Program.
The waiver process and the timelines associated with the waiver process are clearly communicated to students.

See pdf for more information.

Health Information Links in Massachusetts

Gallagher Koster Insurance Agency:
https://www.gallagherkoster.com

Qualifying Student Health Insurance Program:
http://www.mass.gov/dhcfp

MassHealth eligibility and enrollment information:
http://www.mass.gov/dma/

Uncompensated Care Pool
Uncompensated Care Pool

Commonwealth Care Health Insurance Program:
www.mass.gov/connector

To find a community health center near you, visit the community health center directory page:
http://www.massleague.org/HealthCenters.htm

Massachusetts Hospital Association website:
http://www.mhalink.org/public/mahospitals/index.cfm

Access to Health Care in Massachusetts: A Catalog of Health Care Programs for Uninsured and Underinsured Individuals (May 2004):
http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/access_catalog.pdf

Your Guide to Managed Care in Massachusetts (Dec. 2005):
http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/mgd_care_guide.pdf

Massachusetts Division of Insurance (DOI):
http://www.mass.gov/doi

Prescription Drug Assistance Programs:
Prescription Drug Assistance Programs

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