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Student Health Insurance

Medical Insurance Guide and Related Information for Students

We all have financial burdens: tuition costs, credit card debt, student loans. Health insurance is probably the last thing on your mind. But health is the leading cause of college dropouts nationwide. Without insurance coverage, medical bills can trump already existing worries about your budget.


Why do I need health insurance now?

Young adults are more likely than any other age group to visit the emergency room. Health insurance can protect you from the expense of any uninsured hospital stay and the potential for bankruptcy or a financial crisis.


What are the implications of the Affordable Care Act?

The ACA increases access to affordable healthcare for many, and allows individuals who qualify to receive financial aid to help them buy their own insurance. Other changes are as follows:

  • Protection from rate increases
  • Protection from canceled insurance
  • More coverage for preventative care (eg. checkups)
  • No lifetime caps on benefits

       Please visit www.healthcare.gov for more information.


Insurance vocabulary

  • Premium: the periodic payment required to keep an insurance policy in effect. A plan with a lower premium usually comes attached to a higher deductible, and vice versa.
  • Deductible: The portion that you pay before insurance coverage begins. Keep in mind that your monthly premium and co-payments often don’t count toward your deductible.
  • Co-insurance: The percentage you pay when your health plan doesn’t cover 100% of your medical costs. You’ll also see co-insurance described as percentage participation, which applies after your specified deductible is met.
  • Co-payment (co-pay): Your share of a specific healthcare bill charged at the time of service. For example, you may have a co-pay of $20 when you visit a doctor’s office.If you anticipate visiting the doctor’s office frequently, choose a plan with an affordable and consistent co-payment.
  • HMOs: Short for Health Maintenance Organizations. These are organizations that provide or arrange care for insured individuals and groups.
  • PPOs: Short for Preferred Provider Organizations. PPOs are managed care organizations of medical doctors, hospitals, clinics and other healthcare providers that have contracted with insurance providers to provide care at reduced cost.


Make sure you explore your options

Your parents’ plan, school-sponsored plans, non-school-sponsored student plans, insurance through professional associations, Medicaid, state high-risk pools, short-term health insurance, COBRA, low-cost health services and insurance designed for international students.


What if I choose to stay on my parents’ plan?

This is convenient, and you can’t be declined for coverage because of medical reasons. However, because you attend school in Virginia, if you live outside of the state your coverage levels may be decreased. Your parents’ plan may also be more expensive than other options.


Coverage from a school-sponsored plan:

Sweet Briar College is participating in a consortium student health insurance plan with Gallagher Koster. Detailed information and an online chat option for questions are available on their website

FAQ — Frequently asked questions about the 2014-2015 Student Health Insurance Plan for SBC students

Plan Brochure — Information regarding your 2014-2015 Student Health Insurance Plan

Changes Due to the Affordable Care Act — How does the federal healthcare reform affect your student health insurance plan?

Resources & Links — Information available on student health insurance and student health and wellness


Non-school-sponsored health insurance plans

Non-educational organizations and other providers offer a variety of plans for full-time students between the ages of 17 and 29. This coverage stays with you even if you transfer to a different school, but these plans tend to be more expensive. They may not be available in some states, so check with a licensed insurance agent to make sure you’re getting the best deal.

Leverage professional associations

Undergraduate and graduate students studying archaeology or cultural, linguistic, biological or forensic anthropology are eligible to join the American Anthropological Association at a subsidized student rate. As a member, you’ll then be eligible for their health insurance program.


Medicaid

This is a program that offers assistance to individuals and families with low income and resources. You may qualify for Medicaid for a variety of reasons; check with your state’s department of insurance

The ACA also expands Medicaid eligibility for persons under the age of 65 with incomes of up to 133% of the federal poverty level.


Your state’s health insurance pool

Resources are available to provide special health coverage plans for certain residents. Details vary from state to state, and some states do not offer this type of program at all. Unlike with student programs, you’ll be able to maintain coverage under your plan even if you drop to part-time status, take time off from school or finish your studies.


Short-term health insurance 

This is non-renewable, but relatively inexpensive coverage ranging from 30 days to 6 months. These plans are beneficial for those transitioning between jobs, ineligible for COBRA, or visiting a school from another state or country.

COBRA

Students who have turned 26 and are no longer eligible for coverage under their parents may be eligible for COBRA. Check the U.S. Department of Labor for more information.


Low-cost treatment options

If you find yourself uninsured, the Sweet Briar College Student Health Center is a full primary-care clinic that DOES NOT charge for visits. Other options are finding a federally funded community health center, which offers many services at a discount or sliding scale based on income:

  • Amherst County Community Health Center
    • 134 Elon Rd, Madison Heights, VA 24572-2536
    • (434) 455-2480
  • Amelon Immediate Care
    • 200 Amelon Sq, Madison Heights, VA 24572
    • (434) 929-1095
  • Blue Ridge Medical Center
    • 4038 Thomas Nelson Highway, Arrington, VA 22922
    • (434) 263-4000
  • James River Dental Clinic
    • 239 Trojan Rd, Madison Heights, VA 24572-5346
    • (434) 847-4691
  • Johnson Health Center
    • 320 Federal St, Lynchburg, VA 24504-2306
    • (434) 947-5967
  • JHC Pediatric/OB Clinic
    • 407 Federal St, Lynchburg, VA 24504-2459
    • (434) 455-3270


International students

All international students must have medical coverage. Upon being accepted to Sweet Briar, you will be sent information about a minimal accident and sickness medical plan that is provided at a low cost to students through Sweet Briar. We require that you obtain this annual insurance as there is no reciprocity between the United States and foreign countries for free medical care.


Different types of insurance plans

  • Catastrophic Insurance
    • Catastrophic insurance plans generally have lower premiums than comprehensive insurance plans. 
    • Your deductible per medical occurrence will be higher than that of comprehensive insurance plans.
    • If you move to another health insurance plan that has a pre-existing condition waiting period (which is generally nine months), you will be responsible for the entire cost of care for any pre-existing conditions. This can have disastrous financial consequences.
  • Comprehensive insurance
    • Comprehensive insurance plans generally have higher premiums than catastrophic insurance plans.
    • Your deductible will be less than it would be under a catastrophic insurance plan.
    • Your time spent covered under a comprehensive health insurance plan will be credited toward the pre-existing condition waiting period (again, generally up to nine months.) In healthcare, this is called creditable coverage.

In addition to the monthly premium, you will also need to cover your deductibles and co-insurance and/or co-payments, which are out-of-pocket expenses or cost sharing on your insurance bills and other materials. Be sure to read the fine print before deciding on HMOs, PPOs and other traditional fee-for-service insurance plans, as they administer cost sharing policies differently.


Consider your options before deciding

  • Should you use an HMO or PPO?
    • HMOs generally have lower premiums, but fewer choices of medical providers because patients must remain within their network for healthcare. Additionally, special services like MRIs or CT scans have to be approved in advance by the insurance company. You’ll find that your doctor and your insurance provider have to agree on a plan for your healthcare before treatment can be given.
    • PPOs provide a greater choice of providers, but have higher premiums. Generally, the doctor is the only person who makes decisions about your healthcare, and preadmission isn’t necessary for special services.
  • Is your doctor and hospital of choice in the network?
    • Each insurance provider has a different network, so you’ll need to be sure to check your insurer’s website for medical professionals and clinical services that are covered. Inquire which hospitals around your school are in the network.
    • Do your research to find an in-network doctor nearby whose philosophy and reputation appeal to you.
  • Do you have any medical conditions or specific medical needs? Not all plans cover the same medical issues. Below are just a few of the services that may not be covered by all plans:
    • Alcohol and drug treatment
    • Ambulances

    • Annual doctor’s exams
    • Chiropractic
    • Dentistry

    • Emergency room and urgent care visits
    • Holistic medicine

    • Inpatient care

    • Mental health

    • Outpatient hospital care

    • Nutrition
    • Podiatry

    • Pre-existing conditions

    • Prescription drugs
  • Do you need an insurance plan that covers you alone, or do you need a plan for you, your spouse or partner, and/or your children? Plans and costs vary considerably based on the number of individuals covered.
    • Even if you select private insurance for yourself, your children may be eligible for enrollment.
    • Coverage for domestic partners varies depending on provider and state. Make sure to find out if the program will insure your partner before committing to a plan.


Appealing a health insurance claim

If your health insurer denied you coverage for medical care you have received, you still have the right to appeal the claim and ask that the company reverse the decision. Take advantage of these tips to improve your chances of winning an appeal:

1.     Review the literature that accompanies your policy and its explanation of benefits.

2.     Contact the insurance company and keep detailed records of your attempts to contact them (which may include copies of letters, times and dates of conversations in person or on the phone).

3.     Request documentation from your doctor, employer or student health practitioners on campus to support your case.

4.     Write a formal letter that details what care was denied and why you are appealing the decision through the company’s internal review process.

5.     If your claim fails the internal appeal, you can file a claim with your state's department of insurance.

 

Other Helpful Student Health Insurance Resources:

§  Macalester College: Staying Healthy in College Some practical advice offered by Denise Ward, director of Health and Wellness at Macalester College.

§  NY Times: A Maze of Options on Health Insurance for College Students Published in 2009, this article remains relevant as it details concerns for the state of student health insurance.

§  USA.gov: Health Insurance This government-sponsored website contains official information about health insurance, with a helpful checklist for appealing a health insurance claim.

§  U.S. Department of Labor: Continuation of Coverage (COBRA) This official guide, compiled by the U.S. Department of Labor division of Health Plans & Benefits, contains helpful information to demystify the policies surrounding COBRA and continuation of benefits once you’ve stopped working. It contains links to fact sheets and downloadable brochures.

§  U.S. Department of Labor: Frequently Asked Questions about HIPAA Compliance Read through these frequently asked questions about the Health Insurance Portability and Accountability Act, including details about creditable coverage, special enrollments and exclusion of service based on pre-existing conditions.

§  U.S. Department of State: J-1 Visa Be informed about the J-1 visa, which applies to many visiting students from other countries and stipulates rules about maintaining health insurance.