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Student Health Insurance Laws

New Jersey State Law

New Jersey Senate Bill 2291 which amended NJSA 18A:62-15 was signed into law by Governor Christie on July 5, 2013.  The amendments eliminated the previous state requirement that every student who is enrolled full-time at a public or private institution of higher education in New Jersey maintain health insurance coverage which provides basic hospital benefits.  The amendments also eliminate the previous requirement that every full-time student annually present evidence of health insurance coverage and other provisions related to the health insurance coverage requirement. Any requirements for health insurance coverage imposed at the federal level by the Patient Protection and Affordable Care Act (PPACA) would still be applicable.  The changes to the law maintain the requirement that all institutions of higher education in New Jersey offer health insurance coverage for purchase by students who are enrolled full-time.

The amended law does not change how the student health insurance coverage offered by the College is handled by the insurance company or the federal requirements under the Patient Protection and Affordable Care Act.  In meeting the requirement that the college offer health insurance coverage for purchase by students who are enrolled full-time, The College’s current student health insurance offering is underwritten by UnitedHealthcare and was established as a “hard waiver” policy.  This type of policy has a substantially lower premium cost than a “voluntary” enrollment policy having the same benefits.  The “hard waiver” policy requires full-time students to have and present evidence of insurance in order to be able to waive/opt out of the coverage.  So while the NJ law may no longer detail specific obligations of the college and its students, the insurance policy chosen and offered by the college still requires every full-time student to annually present evidence of health insurance coverage if they wish to waive.

While about 20% of the students in the New Jersey State Colleges and University system are not covered by health insurance from another source and need to purchase the sponsored plan, by offering a “hard waiver” policy and including the premium for the student health insurance on the term bill those students who are in need of the coverage are able to get better rates and can receive financial aid to help defray the cost of the insurance.

We recognize that the approximately 80% of our students who are fortunate enough to have health insurance coverage and who may wish to waive are inconvenienced by having to go through the waiver process.   We have made the process of waiving the insurance as easy and convenient as possible by having students complete the waiver forms at The College of New Jersey’s link at http://www.firststudent.com.  On behalf of your classmates who need the insurance, we thank you for your understanding that this slight inconvenience allows them to purchase affordable health insurance coverage.

Federal Laws

The Patient Protection and Affordable Care Act (Pub. L. 111–148) was enacted on March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111–152) was enacted on March 30, 2010. The two statutes are referred to collectively as the Affordable Care Act (ACA). The Affordable Care Act reorganizes, amends, and adds to the provisions of Part A of Title XXVII of the Public Health Service (PHS) Act relating to group health plans and health insurance issuers in the group and individual markets.

Regulations relating to student health insurance coverage requirements were finalized by the Centers for Medicare and Medicaid Services (CMS) on March 16, 2012. The final rule of the regulation established requirements for Student Health Insurance Coverage under the (PHS) Act and the Patient Protection and Affordable Care Act. The final rule defines ‘‘student health insurance coverage’’ as a type of individual health insurance coverage, and specifies that certain PHS Act requirements are inapplicable to this type of individual health insurance coverage. This final rule also amends the medical loss ratio and annual limits requirements for student health insurance coverage under the PHS Act.

What does this mean? There are different requirements for health insurance for group and individual market compared to coverage that meets the definition of student health insurance coverage.  For example, annual dollar limits for group and individual member plans are $2 million for policy years beginning on or after September 23, 2012 but before January 1, 2014.  For the same period, annual limits for student health insurance coverage are $500,000.

For the time period that includes the 2013-2014 Academic Year Student Injury and Sickness Insurance Plan (SISIP), the plan must comply with the new minimum requirements of the Federal Law.  The new requirements include:

  • 100% coverage without copayment or co-insurance for certain preventive services in network.
  • For student health insurance the policy year maximum for essential benefits will not be less than $500,000.
  • No lifetime benefit limits.
  • Preexisting conditions for people under age 19 are covered.
  • Exclusions contradicting terms of PPACA, such as excluding certain preventive care, are removed.

Additional Information

If you are in need of health insurance coverage and you choose not to participate in the new plan, other options may be available to you.  You might be eligible for coverage under a group health plan of your employer or, if you will not have reached the age of 26 by the end of the calendar year, under a group health plan of your parent’s employer or under your parent’s individual health insurance policy.  Contact the plan administrator of your employer’s plan or your parent’s employer plan or your parent’s individual health issuer for more information.  If you are over the age of 26 or if you are not eligible for coverage under your employer plan, parent’s employer plan or parent’s individual policy, then you might be eligible for coverage under an individual policy or through programs such as COBRA.

Please be advised that there are upcoming changes in health insurance requirements under the Affordable Care Act.  Of note, under the new law and effective January 1, 2014, many individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee.

The additional information provided is meant to assist you in your decision making about health insurance coverage, but is not offered as nor should it be construed as or relied upon as legal advice or complete and comprehensive information about your current policy, available coverage or health insurance law.  For additional information, including information about the health care law, finding insurance options, and accessing the health insurance marketplace, please refer to http://www.healthcare.gov.

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