Student Health Insurance Program Regulation in Massachusetts
exist for Student Health Insurance in Massachusetts?
Commonwealth of Massachusetts has set a specific level of benefits for health
insurance plans that are sponsored by a college or university. Since 1989, Massachusetts
has required that all students considered full-time or 75% of full-time while
enrolled in a degree-granting program at an institution of higher learning in
Massachusetts participate in a compliant, school-sponsored health insurance
plan or in a health insurance plan with comparable coverage. This requirement
exists regardless of the student’s state of residency.
You may see the
term ‘QSHP’ as it relates to the regulation of Student Health Insurance
Programs offered by colleges and universities in the Commonwealth of
Massachusetts. In 2009, amendments to
regulations re-named QSHP to ‘Student Health Insurance Program Regulation’ or SHP.
Why was Student
Health Insurance Program Regulation developed in Massachusetts?
established to promote students’ access to quality and comprehensive health
insurance while attending school in Massachusetts. When originally established,
many insurance plans did not provide coverage for dependents who were full-time
students over the age of 19 and the Regulation allowed students to have access
to an affordable health insurance alternative. Additionally, such Regulation
allows international students access to the same coverage of health benefits as
domestic students. Requiring participation in a compliant, school-sponsored
plan or comparable alternative plan also ensures that students will have health
services available in close proximity to their school.
students have to enroll or complete a waiver?
depends on the number of credits in which the student is enrolled. Students
required to enroll (or prove comparable insurance) are 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 the health insurance requirement
is not applicable to them.
registered for a full-time load of online courses subject to the SHP
No. Currently, any student registered in an online program in Massachusetts,
regardless of that student’s state of residency, is not required to participate
in the school-sponsored plan or show proof of an alternate insurance plan of
If a student
already has health insurance, does he or she have to be enrolled in the school
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 annually
at the beginning of each academic year to the school and certify that they are
enrolled in another comparable 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 Massachusetts
regulations. The specific waiver process is dictated by the school, and most
schools choose to use an online system for students to submit waivers. This waiver process must be done on an annual
basis at the beginning of each academic year (or beginning of the spring
semester for those students who begin their academic year in the spring), and many
schools stipulate that waiver information may be subject to audit.
If a student
has insurance through their parents or an employer plan; how do they know if
that is comparable coverage?
plan must provide comparable coverage to that offered through the college or
university. Comparable coverage
includes, but it not limited to, 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.
- Access to
providers in the geographic area of the college or university.
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.
- The insurance
company should be one based in the United States.
parents find it important to look at their 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 (now the Center for Health Information and Analysis). This Division, in
cooperation with the institutions of higher learning in Massachusetts is responsible
for administering compliance with the student health insurance requirement. An
appropriate level of insurance coverage is not only required as a condition of
enrollment, but is necessary to ensure that your child has access to health
care while away at school.
What if a
student doesn’t have health insurance or their coverage is not comparable, how do
they enroll in school insurance plan?
automatically enroll students in the school sponsored insurance 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 via the school’s
designated waiver system.
What is the
percentage of students who enroll in the school sponsored plan?
Massachusetts institutions, the number of students enrolled in the school
sponsored plan is 30-35%.
Do students have
to fill out a waiver form annually?
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.
international students waive out of the school insurance?
In general, 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. However, at their discretion, individual
schools can require that all international students be enrolled in the
school-sponsored Insurance Plan, or they can allow international students to
In the event
waivers are permitted, schools may not grant a waiver request if the student
has coverage issued by an insurance
carrier who is not based in the U.S. or if the plan is not considered
comparable coverage. 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.
Can a student waive
the Student Health Insurance Program (SHP) with any of the Massachusetts (MA)
state subsidized insurance plans such as Health Safety Net or any other
subsidized plan through The Commonwealth Connector?
Students who are eligible for a school-sponsored Student Health Insurance
Plan through their college or university are not eligible to participate
in any of the Massachusetts- subsidized Commonwealth Care programs. These
programs cannot be used to waive the student health insurance plan. Students
are eligible to purchase one of the
insurance plans offered through Commonwealth Choice (unsubsidized), but these
plans should be reviewed carefully as they may have very high deductibles and
often times limited benefits and may not provide benefits comparable to a school-sponsored
If a student is
currently enrolled in MassHealth; can this plan be used to waive the school
MassHealth covers students who are dependents under a family plan until
the age of 19. If you or your student are 19 or older you can still be enrolled
in MassHealth, but only if you meet specific criteria. Contact MassHealth to
determine whether or not you can be covered over the age of 19. If eligible,
MassHealth can be used to waive the school-sponsored insurance plan.
How does Health
Care Reform affect a student’s ability to waive out of the school insurance
If the student is under the age of 26, students MAY be eligible to enroll
as a dependent under the employer health insurance plan held by their parent(s).
However, before doing so, students/parents should fully compare the employer
plan against the school-sponsored plan to determine which plan’s rates,
benefits and coverage are most appropriate.
In addition to the items mentioned in the waiver question above, keep in
mind that Student Insurance Plans are generally less expensive than individual
plans with similar benefits. In fact, total out-of-pocket costs (including
premium and deductibles) may be significantly LESS with the school’s sponsored
plan, especially if the plan carried by the student’s parents or one offered by
an employer is considered a ‘high deductible’ plan or only offers coverage in a
limited service area. In addition, please note that most retiree plans are
exempt from allowing students to continue on the Plan through age 26.
did Health Care Reform make to school-sponsored insurance plans?
For plans that renew on or after July 1st of each year, the
Annual Plan Maximum Levels can be no less than:
· 2012-2013: $100,000
Per Policy Year
· 2013-2014: $500,000
Per Policy Year
· 2014 and beyond: No
Annual or Lifetime Maximum
Additionally, for plans that renewed on or after July 1, 2012, the
following provisions apply for a Student Health Insurance Plan to be considered
· No internal annual
dollar limits can be applied to ‘Essential Benefits’ (number of visits limits
can still apply).
· Preventive care is
covered at 100% without cost-sharing at in-network providers. For more
information on Preventive care coverage (including women’s health coverage),
· Student Plans with
dependent coverage must now cover dependents up to age 26
categories are considered ‘Essential Benefits’?
· Ambulatory Patient
· Emergency Services
· Maternity &
· Mental Health /
Substance Abuse Disorder Services
· Durable Medical
Equipment / Devices
· Prescription Drugs
· Diagnostic Tests
· Wellness / Preventive
Please note that specific definitions and limitations under each
Essential Benefits category may vary by each insurance company.
Who is CHIA/ the Division of Health Care Finance &
On November 5, 2012, a phase of Massachusetts health care reform (Chapter
224 of the Acts of 2012) went into effect, dissolving the Division of Health Care
Finance and Policy (DHCFP) and a new, independent state agency—the Center for
Health Information and Analysis (CHIA)—has assumed many of DHCFP’s
responsibilities, including QSHP/SHP. CHIA has also taken on new roles in
support of its mission to examine health care cost and quality information and
provide objective data and analysis to assist in the formulation of health care
Koster (AICUM partner Student Health Insurance Agency):
Health Insurance Regulations:
Massachusetts Health Connector:
Division of Insurance (DOI):
Department of Health & Human Services HealthCare.Gov:
Kaiser Family Foundation Healthcare Reform Information: