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Author: Hummingbird Insurance

Does a student health plan have to cover essential health benefits?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

It does if it is a “fully insured” student health plan. A fully insured plan is one that your college or university purchases from a health insurance company. If your student health plan is fully insured, it must cover essential health benefits, which include

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services including oral and vision care

However, if the student health plan is “self-insured,” it might not be required to cover essential health benefits. It’s up to states to regulate self-insured student health plans.  Check with your college or university to find out what type of student health plan they offer, or check with your state insurance regulator to find out what rules apply to your student health coverage.

What is a student health plan?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

“Student health plan” refers to a special policy of health coverage that colleges and universities make available to their enrolled students. Typically the student health plan is different from the employer-sponsored group coverage that colleges and universities offer their faculty and staff.

I’m a young adult and I need health insurance. What are my coverage options?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

A number of options may be available to you:

  • If your income is below 138% of the federal poverty level ($16,753 for a single person in 2019), you may qualify for Medicaid coverage. Not all states have elected to expand Medicaid eligibility to this income level. Check with your state Marketplace to find out more about Medicaid eligibility in your state.
  • If your parents have health insurance that offers dependent coverage, you can join (or stay on) their policy as a dependent and remain covered until your 26th birthday. See below for more information about dependent coverage for young adults.
  • You can buy a policy on your own through your state health insurance Marketplace. All plans sold through the Marketplace must meet requirements for covered benefits and cost sharing. Depending on your income, you may be eligible for help to reduce the cost of plan premiums and/or cost sharing.
  • Special, catastrophic policies with very high cost sharing must be offered to young adults under the age of 30. Premium and cost sharing subsidies are not available for catastrophic plans.
  • If you are a student, you may be able to enroll in student health offered through your college or university.

I signed up for Marketplace coverage this year. I am sure I never missed a payment, but the insurer says I didn’t pay the October premium and won’t let me renew coverage for next year unless I repay it. Can I appeal this decision?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

This is unclear.  So far, the federal government has not established a clear appeals process for problems that arise under the rule that permits insurers to refuse to renew Marketplace coverage for nonpayment.  It is important that you sign up for coverage before the end of Open Enrollment.  At this point, options to consider include:

  • Ask your insurer to reconsider. Be sure to present your cancelled check or other proof that you paid.
  • Report this problem to the Marketplace and to your state insurance regulator and ask their help resolving the problem
  • Review Marketplace plan options offered by any other insurers and consider signing up for one of those if you can’t get this problem resolved before December 15.

What happens if I just make up an income level that I know will qualify me for financial assistance?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

That’s not advisable. The Marketplace will check the information you provide against a number of databases (including IRS data, Social Security data, wage databases, and others). If the information you provide is very different from what’s in these databases, you may be asked to provide additional documentation. In addition, at the end of the Application for Health Coverage and Help Paying Costs, you will have to sign that you have provided true answers to all questions to the best of your ability. Knowingly providing untrue information is against the law and could even result in civil money fines.

What documentation is required to request a hardship exemption from the requirement that I have health insurance or pay a penalty?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

For the 2018 tax year, you can claim a hardship exemption directly on your tax return instead of applying to the Marketplace for a hardship exemption.  If you experienced a hardship that prevented you from obtaining health insurance in 2018, you can simply check the box on the front of the federal Form 1040 indicating that you qualify for an exemption.  You will not be required to submit documentation with your tax return, but should retain any documentation of the hardship for your own records.

I expect my income next year will be much lower than it is currently. Do I have to provide documentation to prove my income will be less? What counts as valid documentation?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

You may be asked for additional information about your projected income. The Marketplace will compare your estimated income to other available data on your most recent income (for example, with tax return data.) If you estimate your annual income will be substantially less — by 25% or $6,000, whichever is greater — than the amount you earned in previous years the Marketplace will ask you to provide documentation to support your estimate. This may include a letter from your employer, a pay stub from your new job or other documents. In some cases, just explaining your changed circumstances may be enough.

My employer won’t fill out the form that asks about the affordability of our job-based health plan. I think my job-based plan is unaffordable and that’s why I’m not enrolled in it. Can I go ahead and apply for Marketplace coverage and subsidies without that form?

Written by Hummingbird Insurance on . Posted in Frequently Asked Questions.

Your employer is not required to fill out the form that asks about affordability of your job-based health plan. If for any reason you cannot obtain this information from your employer, you should report to the Marketplace what you know, yourself, about your eligibility for employer sponsored coverage, the cost of that coverage, and whether it meets minimum value. The Marketplace may try to follow up with your employer and collect or verify this information. The Marketplace will determine your eligibility for subsidies based on the information you provided or based on any information the Marketplace was able to obtain on its own through other follow up with your employer.

Although employers aren’t required to provide you this information up front, most are expected to do so.  All employers are required to provide you with this information at year end.  In January, your employer will be required to provide you with a Form 1095-C that indicates whether health benefits they offered to you in the prior calendar year meet the requirements for affordability and minimum value.