Navigating Graduate Student Health Plan Benefits

Choosing a health insurance plan is a crucial step for graduate students. Student health plans are designed with students in mind, offering a valuable solution for their medical needs. These plans often have lower rates because they are based on a younger, healthier population and provide coverage for a limited time while students are in school.

Understanding Student Health Plans

A "student health plan" is a specialized health insurance policy offered by colleges and universities to their enrolled students. These plans are recognized as health insurance under the Affordable Care Act.

Key Features of Student Health Plans:

Essential Benefits: Fully insured student health plans must cover all 10 essential benefits mandated by the Affordable Care Act. These include:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Services for children, including dental and vision care
Contraceptive Coverage: Fully insured plans generally offer contraceptives without cost-sharing.
Self-insured Plans: It's important to note that if a student health plan is "self-insured," it may not be required to cover all essential health benefits.

Health Insurance Options for Graduate Students

University-Sponsored Health Plans

Many universities offer comprehensive health insurance plans designed specifically for graduate students. These plans often provide access to on-campus health services and a network of local providers. Here are a few examples from different universities:

University of Missouri: The University of Missouri partners with student health insurance providers to offer health insurance to support the medical needs of graduate students. The University of Missouri has partnered with a new student health insurance provider starting with the Fall 2025 semester.
University of Kentucky (UK): The Student Health Plan (SHP) at UK is a health insurance plan customized to work well with the on-campus student clinic, University Health Services (UHS). This plan is a Preferred Provider Organization (PPO) provided by Anthem Blue Cross Blue Shield. Using UK HealthCare providers will save money. The health insurance plan coverage includes, but is not limited to: inpatient hospitalization, outpatient doctor’s visits, X-rays, laboratory charges, surgery and emergency care. The plan also includes some preventive care services at 100 percent.
Iowa State University (ISU): For health insurance coverage, you may purchase a Group Health Insurance plan, which covers hospitalization, accident expenses, surgery and maternity benefits for yourself, your lawful spouse or domestic partner, and your eligible children. All students enrolled in more than four credit hours are assessed the mandatory health fee each semester. The health fee enables the availability of high quality and accessible health care to the ISU student community by helping support the overall costs of the health center.
Clemson University: Redfern Health Center (RHC) provides efficient and economical primary care for Clemson University students, but there are times when students may need specialty care that RHC cannot provide. Treatment for an illness or injury that requires hospitalization, diagnostic radiology, surgery or long-term care requires access to facilities outside the scope of student health services. This is a hard waiver requirement administered by RHC. Students already covered by parent, spouse or employer group plans may submit an online request for waiver of the Student Insurance fee. Insurance plans submitted for waiver must comply with the Patient Protection and Affordable Care Act requirements. All waiver requests are verified with the insurance company submitted before waiver will be granted.
University of Iowa: The University of Iowa offers the UIGRADCare plan, a comprehensive health care program that covers hospital, medical, surgical, outpatient, and other health care services, including physical therapy.

Enrollment and Coverage Details

Enrollment Process: At the University of Missouri, to enroll a dependent into the student medical insurance coverage, you need to be enrolled in the student insurance first. If you have created an account with UHCSR from a previous semester, click on ‘log in’ to start the enrollment process.
Coverage Start Dates: Fall semester coverage for domestic students at the University of Missouri begins August 1. Coverage for international students begins August 1.
Automatic Enrollment: At the University of Kentucky, qualifying fully-funded graduate students are automatically enrolled in the Student Health Plan at no cost to themselves. J1, J2, F1 visa holders are enrolled in the Student Health Plan when they register for classes, unless proof of comparable coverage is provided. As a funded graduate student, you will be automatically enrolled into the health insurance plan. For funded graduate students with an F1, J1 or J2 visa - you will see a charge for the health insurance plan on your tuition account. Payments for the plan are posted on the 28th of each month. Once it is determined that you are in fact a funded graduate student, you will see the credit posted to your account on or around the 28th of that month.
Mandatory Coverage: Student Health Plan coverage is mandatory at UK for international students. F-1, J-1 and J-2 students are enrolled in the SHP automatically when you enroll in any class. Health insurance coverage is mandatory for Visiting J-Scholars. Coverage is required for scholars here on an F1, J1, or J2 visa.
Coverage End Dates: At the University of Kentucky, coverage for every student ends on the same date regardless of graduation dates. If you purchase coverage for the Fall semester, your coverage will end on December 31.
Accessing Your Insurance Card: At the University of Kentucky, you can access your card by either downloaded the Sydney Health app on your phone and creating an account using your UK student ID number (without the beginning “9”) or by going to Anthem.com and creating an account there.

Waivers and Alternate Coverage

Waiving Coverage: Domestic students at the University of Kentucky who wish to decline the plan must complete a Declination Form by the specified deadline each semester that they wish to waive.
Waiver Eligibility: In rare circumstances, when a student already has qualifying health coverage provided by an employer, government sponsor or exchange agency, they are eligible to provide documentation of their alternate health coverage by applying for a coverage waiver. When a waiver is approved for a qualifying alternate plan, UK will cancel that student’s eligibility for the SHP for one semester. Waivers must be completed each semester in order to cancel the SHP charge.
Waiver Appeals: Waiver appeals - a waiver appeal can be submitted for International students that will be out of the country for an entire academic semester or that may have a circumstance that is extraordinary. Please note that submission of a waiver appeal does not guarantee an approval. Attempts to fraudulently bypass the standard waiver process will result in an application denial.

Financial Assistance and Subsidies

Subsidies for Graduate Assistants: The cost of the insurance premium depends on the number of family members covered, and whether you are eligible for a subsidy as a graduate assistant. At the University of Missouri, the subsidy will apply only for the semester during which the student holds an assistantship and/or fellowship and will be credited to the student’s University account after eligibility for the subsidy program has been verified. For eligible students in a .50 FTE assistantship (or a combination of 2-.25 assistantships) or a university fellowship at the level of a .25 FTE assistantship, they qualify for a subsidy that covers the full cost of the individual student insurance plan. For eligible students in a .25 assistantship only, they qualify for a subsidy that covers 50% of the cost of the individual student insurance plan.
Free Coverage for Graduate Assistants: At Iowa State University, graduate assistants are automatically enrolled in the medical plan. Graduate students who currently hold a graduate assistantship receive single coverage free of charge in a prescription drug benefit program that reduces the cost of generic and brand-name drugs purchased at the Student Health Center Pharmacy.

Coverage for Dependents

Enrolling Dependents: At the University of Missouri, if you include dependents on your plan, you must first be enrolled in your own plan. To enroll a dependent into the student medical insurance coverage, you need to be enrolled in the student insurance first. At the University of Iowa, if you have a spouse/partner or child(ren) who will need insurance, you must complete an enrollment form in MyUI to add them to your policy.
State Coverage for Children: If you cannot afford the premium the insurance plan that provides coverage for your children, you may choose state coverage. The State of Missouri offers a Health Insurance Program for Children, entitled MC + for Kids for low-income families who do not have access to affordable health insurance.
Additional Fees for Dependents: At Iowa State University, for an additional fee, the spouse and children of a graduate student holding a graduate assistantship may also be enrolled in the Prescription Drug Benefit Program as long as they are also enrolled in the Group Health Insurance plan. Dental insurance for graduate students, and their lawful spouse or domestic partner and families is available and may be purchased for an additional premium.

Marketplace Coverage

Even with access to a student health plan, students can still explore coverage options through the Health Insurance Marketplace. Depending on income, family size, and location, they may qualify for lower costs.

Key Considerations:

Age and Tax Dependency: The next steps for getting Marketplace coverage depend on your age and if you're listed as a dependent on someone else's taxes, like your parent's taxes. If students are under 26 and a dependent on their parent's taxes, coverage options may vary based on their location. If students are 26 or older and a dependent, they can apply for Marketplace coverage on their own or with their parent. However, they might need to choose a separate plan because they're 26 or older.
Financial Assistance: If students accept and enroll in the school’s health insurance plan, they will not be eligible for financial help through Covered California while they are covered by their school’s plan.
Minimum Coverage Plans: If students are under 30, they may be able to buy an additional health insurance plan option called a minimum coverage plan (also known as a catastrophic plan). These minimum coverage plans usually have lower monthly premiums and mostly protect consumers from worst-case scenarios. Catastrophic plans through Covered California cover three doctor visits or urgent care visits, including outpatient mental health and substance use visits, with no out-of-pocket costs, and free preventive care.
Parent's Insurance Coverage Network: When making this decision, students should consider their parent’s insurance coverage network. If students attend a school that is far away from their parent’s home, their parent’s health insurance may not cover medical services provided to them while they are away at school. Students should speak with their parent’s health insurance plan for more information. If the student is going to school outside the state of California, only emergency services may be covered by a Covered California health insurance plan.
Tax Credits: If students are claimed as a dependent on their parent’s taxes and choose to opt out of their student health insurance, their parent’s Covered California family plan would still be eligible for tax credits. Additionally, if students choose to stay or accept their student health plan, their parents would still be eligible for tax credits through Covered California, if otherwise eligible.
Out-of-State Coverage: If students are tax dependents, they can be covered under their parents’ Covered California health plan, no matter where they live. However, Covered California does not offer any health plan products that have a network of doctors, hospitals or other health care providers outside of California at this time. Therefore, if the school the student attends is out-of-state, the parent’s health insurance will not cover most medical services while the student is away at school. The exception being that all emergency services must be covered at the in-network price, even if the service was received out of state.

Maximizing Your Health Plan Benefits

Familiarize Yourself with the Plan: Participating in a student health plan does not mean all of your health care is free. It is your responsibility to familiarize yourself with the plan. The best way to make this coverage (or any health plan) work for you is to be informed and proactive. If possible, check the covered benefits before you receive medical care.
Utilize On-Campus Resources: Student health plans are often designed to work well with on-campus student clinics. Taking advantage of these resources can save you money and provide convenient access to care.
Check Provider Networks: Understanding the health care providers you choose will affect your out-of-pocket expenses.
Stay Informed: Keep track of enrollment deadlines, waiver requirements, and any changes to your health plan.

Read also: Funding Your Graduate Education

Read also: Graduate Fees at CMU

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