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Do student health care plans have to cover preventive care at no charge?

Most student health insurance plans must include preventive care and cannot impose any cost-sharing for certain recommended preventive services. | Image: rocketclips / stock.adobe.com

Q. Do student health care plans have to cover preventive care at no charge?

A. Yes (with the exception of some self-insured student health plans). Student health insurance plans must include preventive care and cannot impose any cost-sharing for certain recommended preventive services.

From the perspective of the enrollee, student health insurance plans are fully compliant with the ACA, which includes covering the essential health benefits. And certain types of preventive care at no charge is one of the essential health benefits.

This includes vaccination for COVID-19. The vaccine was recommended for inclusion in the regular vaccine schedule as of December 13, 2020. Under special rules implemented by the CARES Act, private health insurance plans — including student health plans — must incorporate coverage for COVID-19 vaccination within 15 business days of the date the CDC’s vaccine committee (ACIP, or Advisory Committe on Immunization Practices) made the recommendation.

In the Benefit and Payment Parameters for 2017, HHS clarified that student health plans do not have to fall within the narrow actuarial value parameters that apply to metal level plans in the rest of the individual market. And they also do not have to be combined with the carrier’s other individual market business in a single risk pool. These adjustments make it easier for health insurance carriers and universities to continue to offer student health insurance, but their impact from the students’ perspective is minimal. Students can rest assured that the coverage they’re buying through a university is fully compliant with the ACA, unless it’s one of the aforementioned self-insured student health plans, some of which have opted out of ACA compliance.

Read more FAQs about health reform, and student health insurance.

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