How student health insurance plans work

A student health insurance plan is coverage your school arranges with an insurer for its students. Here is how one works from enrollment to a claim, so you can read your own school's plan summary with a clearer sense of what each part means.

What these plans are

Colleges and universities contract with an insurer to offer a plan to enrolled students, and sometimes to their spouses and children. Most of these plans are treated as individual coverage under federal law, so they generally have to cover the essential health benefits set by the Affordable Care Act.

Schools set their own rules about who must have coverage. Some require every student to carry health insurance and enroll anyone who does not show proof of another plan, while others offer the plan as an option. International students and students in some health programs often face a firm requirement.

How the plan is billed

The premium usually appears as a charge on your student account for each term or for the full year. The plan year often matches the academic year, and coverage over the summer may depend on whether you enrolled in the spring or fall.

Because the charge sits on your student bill, ask the financial aid office whether the cost is included in your cost of attendance. That figure affects how much aid the school can offer, so the answer matters if you need help paying.

Before the term starts

• Whether your school requires coverage
• The plan's start and end dates
• The deductible and out-of-pocket maximum
• Whether referrals are needed
• How to reach member services

Reading the summary of benefits

Every plan publishes a Summary of Benefits and Coverage, a standard document that lists the deductible, copays, coinsurance and out-of-pocket maximum. The deductible is what you pay before the plan starts sharing costs, and the out-of-pocket maximum caps what you pay for covered in-network care in a plan year.

Many student plans ask you to start at the campus health center and get a referral before seeing a specialist. Check how the plan handles care when you are home on break, since the network may be built around the campus area.

Using the plan

You usually receive an insurance card by mail or through an online portal after the term starts. Bring it to every appointment and pharmacy visit, and keep the plan's member services number where you can find it.

If a claim is denied, the plan has to tell you why and explain how to appeal. The student health insurance office on campus can often help you read the notice and decide what to ask the insurer.