Brief Overview of Comparable Coverage for Minimum Benefit Guidelines:
- Access to Care: Your health insurance plan must provide comparable coverage in the Springfield, Massachusetts area in order to be used for a waiver.
- Athletes: who need the student health insurance MUST enroll in or waive the insurance PRIOR TO participating in athletic practices or events. We suggest completing the enrollment at least 10 days in advance.
- Disallowed Health Insurance Plans: Coverage cannot be waived using the following plans:
- Massachusetts: Health Safety Net, MassHealth Limited, the Children’s Medical Security Program
- Out-Of-State: Medicaid plans (except HuskyHealth)
- International Students: Are automatically enrolled if they are in a program of study that requires them to participate or if they are a student athlete
- Processing Time for a Waiver or enrollment: Normally within 3 to 10 business days.
- Student Under the age of 18: Waiver requests must be confirmed by a parent or guardian.
HEALTH INSURANCE PLAN COMPARISON CHECK LIST (Minimum Benefit Guidelines)
Use the following grid to determine whether the plan you’re considering is comparable to the Student Insurance Plan. Your plan must be compliant with Massachusetts regulations and the Patient Protection Affordable Care Act (PPACA). It is your responsibility to review your plan and talk to your insurance agent about any questions you have on your plan.
If your plan doesn’t meet, at a minimum, the following requirements, you cannot waive the Student Health Insurance Plan.
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My Plan
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Minimum Health Insurance Plan Comparable Coverage Requirements
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Yes
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No
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1. A network of doctors, specialists, and hospitals within 30 miles of the AIC campus in Springfield, MA (local area) effective from the beginning of the period of enrollment. All coverage requirements listed in items 3 through 12 must be available within the local area.
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2. An insurance company whose home office is based in the United States and whose plan is filed and approved in the US, and compliant with the Affordable Care Act (ACA).
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3. An unlimited plan maximum benefit. This means no maximum benefit per illness or injury per coverage period or per lifetime
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4. Immediate Coverage for Pre-existing Conditions; no waiting period for services [In addition to looking at what’s covered, check the list of exclusions and limitations].
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5. Emergency Services Coverage – no limits on coverage
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6. Maternity Coverage and Coverage for Newborns - no limit on coverage
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7. Mental Health/Substance Abuse, no limits outpatient or inpatient – no dollar limits or days of treatment limits
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8. Pharmacy Benefits - no maximum dollar amount
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9. Preventive Care and Primary Care Services
This means coverage for routine physicals, physician visits exams, gynecological exams, coverage for preventive lab tests, preventive immunizations and vaccinations.
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10. Surgical services – no maximum dollar amount
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11. Hospitalization Benefits – no maximum dollar amount or limit to number of days
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12. Ambulatory Patient Services – no maximum dollar amount
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If you answered “NO” to any question (1-12) then your plan is not comparable
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13. Do you have Massachusetts Health Safety Net, MassHealth Limited, or The Children’s Medical Security Program?
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14. Do you have an out-of-state Medicaid Plan other than Connecticut Husky Health*?
*Connecticut Husky Health is considered comparable coverage. Please answer "No" to this question on the waiver form if you have Husky Health.
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15. Do you have a plan that you purchase on a month-to-month basis?
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If you answered “YES” to questions (13 , 14 or 15) then your plan is not comparable
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