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Student advocates ask state to audit health insurers

Published: October 21, 2011
Section: News


Last month, a coalition of student and advocacy groups asked the Division of Health Care Finance and Policy to investigate regulations pertaining to co-insurance, according to a press release from Mass-Care. They maintained that according to the regulations for the Student Health Insurance Plans, co-insurance falls outside the parameters allowed for excludable coverage.

Massachusetts requires everyone to have health insurance and universities offer a basic level of care to students without other insurance. At Brandeis, the student health insurances have no copays or co-insurance cost shares for in-house services, and the insurance, which the university has developed, covers a multitude of events or accidents that commercial policies avoid, including accidents while inebriated and mental health care.

It is common for universities to provide more comprehensive care than required by law but most coverage focuses on treatment rather than preventative care.

“It’s a one-year health plan,” explained Diana Denning, director of the Brandeis Health Center, “So they’re not invested in your lifelong health, just for that one year.”

There are copayments for wellness benefits like immunizations, which have recently been added to the health center’s repertoire. According to Denning, some Massachusetts universities, including Tufts, might be looking to pool their insurance “in order to contain health care costs” and make it more affordable for students.

Co-insurance charges a percentage of the cost of a medical procedure instead of a static amount such as a copayment and has become increasingly common in health plans offered by universities.

Health care advocacy groups contend that the cost is prohibitive to students, a population often forced to choose between necessities during financial strain. Many students now face 15 percent co-insurance fees that can amount to thousands of dollars.

Students have begun to contest the legality of percentage-based payment, as it is not explicitly excluded from what insurers are bound to cover, like “charges reimbursable by any other valid and collectible medical insurance plan” or athletic injuries covered by another policy, according to Mass-Care.

In fact, most of the stipulations in the Division of Health Care Finance and Policy’s regulations are excluded only when covered under another insurance plan. Only “reasonable copayments and deductibles,” which may not exceed $250 annually, are acceptable forms of cost-sharing with the policy holder.

Though students are now allowed to remain on their parents insurance until age 26 through the Affordable Care Act, many still rely solely on their university for insurance. The coalition states “co-insurance has increasingly come to be used to impose high cost sharing outside of the Division’s stated limits on copayments and deductibles,” which negates many of the recent consumer protections ensured by the Affordable Care Act.

Graduate students older than 26 notice a significant impact on their coverage. SHIPs are sometimes their only affordable health coverage option and many of them also have families who are covered on their plan. An emergency room trip that previously cost $100 can now be in the thousands. The cost of co-insurance payments can put medical treatment out of reach, even when a student has insurance.

The student health coalition has asked legislators to donate money to help cover the co-insurance payments of students unable to afford necessary medical care. Dr. James Recht choruses the fears of many in the medical profession. “Co-insurance acts as a strong disincentive to obtaining necessary care—co-insurance should not be permitted for student health plans, it puts care out of reach for those who need care the most,” he said in a press release from the Massachusetts Campaign for Single-Payer Health Care

Many are concerned that the complexity of the system only allows the industry to be more expensive because people don’t know their coverage or the exact provisions of their plans.