The comparable coverage requirements for alternate insurance plans have changed for the 2016-2017 academic year! Waivers will be denied if all of the following criteria are not met.
Alternate insurance plans:
- Must provide routine, non-emergency care, in addition to emergency care, in the Chicago area*.
- Must provide “essential health benefits” per the Affordable Care Act (ACA); see details below.
- Cannot exclude pre-existing conditions, or have waiting periods before coverage applies.
- Must provide active coverage from the day the student arrives on campus through either August 10, 2017 or the end of their academic program (whichever comes first).
- Must cover medical evacuation and repatriation expenses (for students who will reside more than 100 miles from their permanent address during the academic year).
- Annual out-of-pocket maximum limits: individual insurance plans < $6,350; family insurance plans < $12,700.
Auditing for Compliance
Beginning in 2016-2017, all students who waive SXU Health Insurance enrollment will be audited to ensure their insurance plans meet the University’s requirements for comparable coverage. Students will be given an opportunity to correct and/or update insurance information if they fail an insurance audit, e.g., inaccurate data entry, coverage no longer active, plan does not meet all waiver requirements, etc.
If your alternate insurance plan fails an insurance audit, you will have 10 business days either to supplement your existing plan or find a different plan that fully meets the University’s comparable coverage requirements; otherwise, you will be reenrolled in the University Student Health Insurance Plan for the entire academic year, and you will be billed the semester premium installments.
Essential Health Benefits, per the Affordable Care Act (ACA)
In addition to the criteria noted above, all alternate insurance plans must include the following benefits, as required by ACA:
- Outpatient Care (ambulatory patient services)
- Emergency Services
- Hospitalization (treatment for inpatient care)
- Mental Health Services and addiction treatment
- Prescription Drugs
- Maternity and Newborn Care
- Rehabilitative Services and Devices
- Laboratory Services
- Inpatient Mental Health Care
- Preventive Services, Wellness Services and Chronic Disease Treatment
- Pediatric Services
*If a student will be studying abroad, routine and emergency care -- and all coverage requirements noted above -- must be provided in the local area where the student will be studying/residing.