Coed care: U.S. colleges and universities try to convince the "invincible" that health insurance is a good idea

Oh, to be in that generation that feels immortal-the generation of college students. Unfortunately, that feeling of immunity often can lead students to some poor decisions when considering healthcare benefits.

"It is a healthy population without a perceived need for insurance," says Don Atherton, president of Integrated Benefit Solutions in Houston. "They have to be motivated to seek out coverage when they would rather pay the rent than buy health insurance. The issue then becomes filling in the gap since they may not be eligible for dependent coverage, have a pre-existing condition or are uninsurable."

According to the Henry J. Kaiser Family Foundation, about 25% of public colleges and nearly all private ones require students to have health insurance plans. While others may take advantage of their parents' insurance, between 10% and 30% of students are uninsured at schools where health insurance is optional.

A 2004 survey by Sunbelt Insurance of 47 universities across the country showed that 85% did not require health insurance as a condition of enrollment; only five universities required a hard waiver-coverage necessary as a condition of enrollment- although students may waive the university-sponsored student medical plan if they provide proof of acceptable existing coverage. The remaining two schools in the survey adopted a soft waiver allowing students to opt out of the university-sponsored plan without showing proof of existing coverage.

Stephen L. Beckley, head of SLBA in Fort Collins, Colo., a healthcare management consultancy specializing in higher education, is an advocate of mandated health insurance for students, which he says serves as a college recruitment tool. He outlines many of the benefits: avoiding adverse selection; spreading risk over a larger number of individuals; enabling the development of high-quality, affordable insurance plans with full benefits; access and affordability for uninsured and underinsured students; increased student retention; higher use of preventive services; and lower healthcare costs.

The American College Health Assn., although not a governing body, has instituted standards to guide colleges and universities in developing appropriate student health insurance programs. They include requiring a hard waiver as a condition of enrollment, adequate healthcare services offered on campus, competitive vendor selection processes, and an annual review to ensure that the student insurance plan meets student needs, remains affordable and is available to all eligible students.

STATES STEP IN

On the state level, Massachusetts, Idaho and New Jersey mandate health insurance for students attending college in their states. With Massachusetts attracting so many students from around the country, Dan Fishbein, head of healthcare alliances for the Chickering Group, says that without mandatory health insurance, students would place a drag on the healthcare pool.

Chickering, a full-service insurance broker and administrator and an Aetna company based in Cambridge, Mass., sells health insurance programs directly to schools instead of individual students. With college students representing about 10% of the U.S. population, that is a large target market. Fishbein believes that many students will remain on their parents' plans but as employers lower contributions to benefits, plans like Chickering's will become more competitive.

In October 2004, the Idaho State Senate proposed that the Idaho State Board of Education mandate a way for students to acquire better coverage for lower premiums. This proposal is in addition to Idaho's 2002 provision that each institution provides the opportunity for students to purchase health insurance.