<p>I know its early in the process for most folks, but we’re trying to figure out what to do about health insurance for my daughter when she goes off to college. Our HMO will only cover hospitalization/emergencies when she is out of our service area, not local more routine doctor visits. The college she’ll be attending has limited on campus health care (doctor visits three days a week, nurse 5 days a week, no health care on the weekends). We can buy some sort of student health plan from the school, but haven’t yet looked at what it will cover (I suspect only on campus treatment). D. has some ongoing health issues that may require her to see doctors/specialists from time to time throughout the year. </p>
<p>So, any suggestions or advice from those who already have kids in college on health insurance issues? What should we ask about the student health plan, and what do they typically cover? Should we look into getting her insured separately? And so on…</p>
<p>Carolyn, student health plans only offer catastrophic coverage for the most part. And there is generally a significant deductible. So they’ll cover emergency hospitalizations, but not specialist or even primary care preventive visits or medications. Campus health services also do not provide ongoing care for students, but episodic “as needed” care for simple infections, headaches, flu, etc. For kids who have always been extremely healthy, this is generally OK. However, if your child has an on-going chronic problem and you belong to an HMO, I suggest you contact your health insurer about a college “rider” policy to your own health policy to cover his/her care issues. Alternatively, at open enrollment time you might need to consider switching to a PPO or POS plan which costs more, but provides coverage to out-of-network providers and, often, doesn’t require a PCP referral for specialist care.</p>
<p>Carolyn, Have you talked with your HMO and told them that your daughter is going far away to college? If she is actually living away from home, I cannot imagine their not providing complete coverage for her in the new place. As long as she sees a participating provider, in-network, the HMO should be agreeable to that.</p>
<p>I might have to take that back, because I just went to our Aetna website, and did a general search for all primary care physicians in Chicago with our PPO plan, and came up with hundreds of names. (We live 1200 miles away). Then I did a similar search using the Aetna HMO plan, and came up with zero. I am shocked!!!</p>
<p>You should still call your plan and discuss it with them. We have an HMO in MA and my daughter has very limited options for care in NYC. However, I called and pressed the issue a bit and discovered that we can go through a review process that if approved would make her eligible for out of network coverage in NYC.</p>
<p>Our coverage is the same no matter where we are, and pretty lousy (25% copay after $1K deductible per person) at that, so my perspective is warped. We bought the college insurance and have found it covers pretty much everything our kids need, so stopped worrying. </p>
<p>However, I recently looked into individual coverage for my son, and discovered it was quite cheap ($70/month) to buy catastrophic ($2500/year deductible) insurance but hugely expensive (upwards of $200/month) to buy more than that. </p>
<p>It seems to me that there are three choices not discussed by previous posters: use your home health care to cover the major issues and the school insurance for the rest (if they’re good, and many of them are); buy another policy for your D that provides complete coverage; self-cover the minor stuff and buy a catastrophic policy. </p>
<p>You mention a need to see specialists. If your child is home regularly and the doctor visits are predictable, you may be able to schedule them for the frequent school breaks. After almost three years of college, our kids still see our “home” dentist, for example, because they’ve found it much easier to see scheduled doctors during break.</p>
<p>Our HMO will only cover non-emergency services for college students who live away from home if the student has a primary care provider in that area. We learned this after our oldest daughter had a knee injury at school - her ER visit was covered, but follow-up care wasn’t. It could have been, we later learned, had we chosen a primary MD from a list of participating doctors in an area HMO approved by our own. Our HMO, of course, didn’t call this possibilty to our attention ahead of time. The customer service rep (you should pardon the expression) sniffed that “it’s in your [214 page long] contract” when I called to question why we hadn’t been informed of this requirement. (I hate, hate, hate our HMO.)</p>
<p>My middle daughter is at Vanderbilt, where there’s an excellent student insurance plan for about $600 per academic year. Students are required to take this plan if they have no other coverage, and are allowed to take it in addition to their existing plan, if they choose. Not cheap, but it covers a LOT and the services are available at Vanderbilt Medical Center right down the street if the infirmary facilities aren’t adequate for the situation.</p>
<p>True, true, true.
Back in the day when we had HMO coverage, each family member had a different primary care physician. Hopefully your HMO will allow you to select one that is local for your daughter. Don’t forget to ask about lab-work, prescriptions, etc. When labwork is normally covered at 100%, we tend to forget what the actual cost is. My D inadvertently went out-of-network for labwork, and we received a bill for $1100!!! Our PPO is covering half, but we are in mediation still.</p>
<p>AAAAiiiiieeee - health insurance companies - as a physician they actually rank below malpractice attorneys, the devil, and CMS in our pantheon of evil.</p>
<p>Now that the rant is finished - your HMO could fit any one of the scenarios listed, or another not even suggested. Visit with your benefits manager at work, your child won’t be the first to go out of state to college. I have the luxury of being boss and employee, with the “benefits manager” being our office manager. Last year, as my daughter was applying to college, we did a review of our health insurance plan, taking into account that she would likely be out of state/network, and chose a plan accordingly. Most folks don’t have the luxury to pick the plan for the whole business, but if you work at a larger company there should be some options - don’t forget the possibility of switching to a spouse’s insurance if it has more favorable terms for her.</p>
<p>The thornier issue is what to do with chronic illness. If I had a child with “surgical type” problems (I know your daughter has had issues with her jaw, Carolyn), I would try to keep her plugged into her local specialists, if I was satisfied with their care. If that is logistically impossible, I would begin the process of getting a referral, and having medical records transferred, about 6 months before school starts - simply by saying to the doc at a visit a few months in advance “She’s off to school in X time, what is the plan for her care, who can she see?”. It will take about 3 months to get the records copied, referral made, and your child to get an appointment at the new doc. One thing docs really hate about HMOs is when they break up referral patterns - most MDs prefer to send a patient to someone they know and trust. Even going across country, there may be a recognized expert in a certain field, or a certain med center with a top-notch rep or even a local guy that your doctor did his residency with, who he knows is well-trained and trusts, those are the people he will want to refer his patient (your child) to.</p>
<p>An issue for parents with children with chronic illness to consider - if your child is at an isolated or small town school, and they have no car, how to get to appointments. Urgent/emergent care will happen, it is the routine maintenance stuff that has to be planned for. Kids without chronic conditions, can get by with their old doctors/dentists.</p>
<p>Carolyn- we have a ppo and when D was headed to Tulane we made phone calls and started working on referrals to Drs and therapists in late April. It took quite some time to get everything set in place. It ended up that Blue Cross PPO providers were in more abundance there then where we live. When Katrina hit and she ended up at a new school we weren’t prepared.
She intially went with the therapists on campus. This didn’t work out and she is now working on setting up an appointment with someone off campus. This is a lot harder to do once they are actually in school and with all the stress that comes with that it is an added burden. There is the logistics of transportation as well as finding a block of time that works.
For her other health issues. She has had great asthma care and allergy care from the health center Dr’s. She has had breathing treatments and a shot for an allergic reaction at no cost. She also had great followup care after an asthma hospitalization. She needed some bloodwork done and they would not do that with the basic plan. She would have had to go off campus to a lab covered by our health insurance. Since we wanted it done right away we went ahead and had her do it on campus out of pocket. The cost was quite reasonable. She saw her old asthma Dr when she was home for her break. He is working on getting her a referral just in case she needs it.
With her hospitalization- the school health center made a point of checking what health insurance she had before deciding what hospital to send her to. Your child should know what is the preferred hospital for your health plan otherwise it will be quite costly.
Medications- her health center has a very limited pharmacy. She has to walk about 20 minutes to reach a pharmacy. That walk can almost be impossible when you aren’t feeling well. If the dosage is on a regular basis you could fill it at home and mail it.
Transportation to an from the Dr and pharmacy are things that we take for granted and don’t even think about. For a college student in anywhere but a urban area with good public transportation it is a concern.</p>
<p>Viewing student health insurance from a different perspective, sometimes its in a parents best interest not to claim a child as a dependent on their tax return, letting the student claim themselves on the students own return. If this is the case, read your policy carefully as students that are not claimed on a parents income tax return as a dependent may need their own health insurance and may not be covered on the parents policy.</p>
<p>Carolyn,
My co-worker has a HMO. Her daughter is in her second yr of medical school in MO. I was suprised that she has been able to plan or postpone appts till she comes home on breaks. It really wasn’t bad. Fortunately no emergencies but they would be covered. The university has a decent health center but the daughter is always complaining about the quality of the care (it is just her nature to complain about anything she can’t choose for herself).
No regular appts are covered there by insurance. She has done ok with the Rx’s, her mom sends them to her. The policy only covers meds if they are mailed to or picked up in CA. The girl is dropping off this year (getting married) and is getting her own policy. She is looking forward to seeing specialists in MO but the policy is about $100/mo, $1000 deductible and no RX coverage. She hopes to get low cost birth control from the school, a cheap generic rx from hospital rx, and free drug from one drug company.</p>
<p>I bought the on campus plan for my son that all internationals must have. It cost $400. It covers travel etc. He has visited the health center once so far because he had a cold or flu or something. He got some meds. I kept him on my plan here because of problems he had last year just in case we had to go back to the docs and I probably will continue that way into next year. Because he did have a problem last year, I realized how important all these policies are. Up until that point, I would have been clueless that young so called healthy people can get very sick, very quickly.</p>
<p>Thanks so much everyone. I have printed this entire thread out and given it to my husband who is going to pursue all of the various avenues. There are many questions that we now know we need to ask, both of our insurer, the college insurance policy, and any additional plans we may need to buy for her while she’s in college. I appreciate all of the advice and help!</p>
<p>Another for contacting the plan. Some plans will only charge you the co-payment if your D sees a doctor that is in network. Either way, now is a good time to find out exactly what your plan will and will not cover. </p>
<p>At some schools (I know dartmouth for a fact) sets a minimum standard of insurance that you as the parent must have for your student in order to get a waiver from purchasing the college health insurance plan. </p>
<p>*Dartmouth students may waive enrollment in the Dartmouth Student Group Health Plan (DSGHP) by demonstrating qualifying coverage with another health insurance or health plan. This is done by providing the DSGHP Office with a waiver petition signed by a representative of the health insurance plan.</p>
<p>The plan representative must indicate on the waiver petition the following conditions:</p>
<p>The Plan provides coverage for urgently needed/medically necessary care in the Hanover, New Hampshire area. </p>
<p>The Plan provides coverage for inpatient and outpatient mental health care and substance abuse treatment. Benefits include at least fifteen (15) outpatient mental health visits in the Hanover, New Hampshire area. </p>
<p>The Plan has a maximum plan year benefit that is $500,000 or greater. </p>
<p>The Plan will remain in force or is renewable for the entire academic year. </p>
<p>All four conditions and the plan representative’s signature must be provided at the start of the academic year for DSGHP enrollment to be waived.</p>
<p>Hi Carolyn. We’ve talked about Beloit before. I work as a health insurance broker and I can tell you that this can be a real problem. This is a quote from the Beloit website: " HMO policies may not cover the student. PLEASE check with your employer regarding HMO restrictions. We have experienced many problems in getting the needed care for students, especially those out of the insurance service area, due to lack of coverage by HMO’s (i.e. doctors’ appointments, physical therapy, etc.). If this is a problem you may want to consider additional coverage for the student while on campus. "</p>
<p>Actions steps: (1) Is your HMO national in scope (Aetna, CIGNA, UnitedHealthcare), or regional (Kaiser, Pacificare); if national ,are there adequate providers in the specific area where the college is located. This provider information is on-line; (2) Do you have the ability to join a PPO plan. PPO plans allow coverage for “non-network” providers, albeit with greater out of pocket costs for subscribers. If the PPO is national you can probably get adequate coverage almost everywhere in USA. (3) Investigate the student insurance plan as a supplement to the HMO coverage which will cover “emergency” care but which will not cover “non-emergency” care. If I can provide any more details please contact me.</p>
<p>Carolyn, I have always had separate policies on my kids than myself – it just always worked out cheaper that way. So your best bet may be to drop your daughter from the HMO and put her on her own PPO plan - you will want to check eligibility first, of course. </p>
<p>If you are considering a separate high-deductable plan for your daughter, consider an HSA plan- one that qualifies for a health-savings account. This lets you pay the deductible amount into a tax-sheltered bank account, and you can make withdrawals from the bank account to pay for health costs using a debit card or checks. These accounts tend to have lower premiums and essentially are giving you the ability to bank your deductible. </p>
<p>(Also - I know this doesn’t apply to you, but its a potential winning strategy for legitimately transferring assets to lower EFC in determining financial aid – if a kid has money in a personal savings account and $2000 is placed into an HSA, that would reduce EFC by $700. )</p>
<p>My daughter had shoulder surgery 10 days before starting her sophomore year in college. We have PPO insurance and I was able to find physical therapists within walking distance from her college. She saw a physical therapist for a few sessions while she was still home for the summer so she knew the basic exercises before she left but the PPO allowed 10 sessions out of network with almost full coverage. Happily, her shoulder healed quite nicely. She is in graduate school now and I still schedule dental, eye and other appointments during December or during the week or so that she is home during the summer. She just got a new retainer when she was home last month and the orthodontist office was extremely helpful in terms of scheduling appointments around the dates she was home.</p>
<p>I am also wondering if perhaps the student could get a part time job where she could purchase benefits? I am a case manager, work with insurances and am well aware of the “out of network” stuff. It’s catastrophic at times. but my plan does allow you to get coverage if you get a waiver before hand, IE) if you are planning a trip to another country etc. talk to your plan customer support to check. also, your child may qualify for medical assistance in whatever place she is going, since they only take into account the income of the person applying. it’s a consideration…</p>