Coverage Comparable to the Colby-Billed Student Health Insurance Plans

Before waiving the Colby Student Health Insurance Plan (SHIP), students should review the details of their own coverage to ensure it is comparable by meeting the requirements below:

• U.S. Based Insurance: The health insurance plan must be provided by a U.S. ­based insurance company or U.S. ­based subsidiary. Foreign insurance plans are not accepted. Neither a U.S.­ based Third Party Administrator (TPA), nor a U.S. Satellite office of a foreign company meets this requirement. The insurance provider, itself, must be U.S.­ based (unless the student is studying outside the United States).
  • A U.S.­ based provider means that the insurance company issuing the plan is a U.S. or domestic company, regardless of where the policy is purchased or where the claims are processed. 
  • Insurance providers outside of the U.S. are foreign or foreign­-based insurance companies (i.e., non­-domestic or non­-U.S. companies), including those companies with satellite offices in the United States. 
  • Travel insurance plans are not considered to provide comparable health coverage and would not qualify for a waiver.
• Comprehensive Coverage: The plan must provide reasonably comprehensive coverage of health services, including preventive and primary care, emergency services, surgical services, hospitalization benefits, ambulatory patient services, and mental health services, and be reasonably accessible to the student for use in central Maine. Plans not meeting this requirement are not accepted.
  • Colby requires comparable coverage plans to provide reimbursement for more than just emergency medical services within the State of Maine (many regional HMO plans do not provide such coverage).
  • Comparable coverage plans must also be compliant with the Affordable Care Act (ACA) by having out-of-pocket maximums at or below $8,150 per individual or $16,300 per family.
  • A health insurance plan which provides coverage through a closed network of  providers, not reasonably accessible in central Maine, for all but emergency  services, does not qualify for a waiver.
    • Examples of these closed networks include students enrolled in MassHealth, the Children’s Medical Security Program, the Health Safety Net, Kaiser Permanente Insurance, and out-of-state Medicaid programs.
  • Health care sharing plans do not offer comparable coverage (examples: Zion Health, One Share Health, Christian Healthcare Ministries) and would not qualify for a waiver.

• No Annual Limit: The plan must not impose an annual limit on the dollar amount of required essential health benefits for any covered individual.
• Coverage for Mental Health & Substance Abuse: Mental health and substance abuse must be covered as mandated by the State of Maine.
• Coverage for Pre-Existing Conditions: There must be no limitations for the coverage of pre-­existing medical conditions.
• Prescription Drug Coverage: Prescription drug coverage must be as high as the plan maximum – as per ACA health reform mandates.
• Coverage for Emergency Medical Evacuation: If you will be studying outside of your home country, emergency medical evacuation­ repatriation coverage must be included.
• Embassy-Sponsored Coverage Requirements: Embassy­-sponsored students, for whom their embassy provides comprehensive U.S. based coverage as described, are eligible to waive, as indicated below:
  • Embassy-sponsored plans must provide fully comprehensive and accessible domestic coverage to be deemed comparable by the College.
  • An embassy­-sponsored plan that requires the student to pay up­front for ambulatory or hospital services, and then seek reimbursement afterward, will not be accepted. 
  • An embassy-sponsored plan that does not provide comprehensive coverage, including chronic disease management, prescription drug coverage, mental health services, and substance abuse, will also not be accepted.

We understand that these details are extensive. If you do not know whether your coverage meets the conditions above, contact the administrator of your own health insurance plan to get current and accurate information about your plan before completing the waiver. Students should compare the benefits, limitations, and exclusions of their own health insurance plan with those provided by the Colby SHIP before applying for a waiver.

Other Tips for Comparing Coverage

To assist in comparing coverage, you can contact the provider of the Colby SHIP, the Wellfleet Insurance Company, at (877) 657-5030, or for more complex questions, you may contact Cross Insurance, Colby’s broker for the Colby SHIP, at [email protected] or (800) 537-6444. When comparing coverage, we recommend that you consider the following:

• Premium – the cost you pay to keep your insurance policy active, charged to you on a monthly or yearly basis. 
• Copayment (or Copay) – a fixed cost for each medical visit, at an amount set by your insurance provider (often between $10-$50).
• Coinsurance – the percentage of the specific services provided at your medical visit that is covered by your insurance provider, and the remaining percentage left to be covered by the patient.
• Deductible – an amount that patients need to pay for their own healthcare first, before their insurance provider will start covering the cost of care.
• Out-of-Pocket Maximum – the maximum amount that patients will be expected to contribute out-of-pocket on a yearly basis toward their healthcare costs (e.g., in copayments, coinsurance, deductibles, etc.). Once this upper limit has been reached, the insurance plan will pay for 100% of the remaining healthcare costs for the rest of the year.

When comparing plans, it can be helpful to consider the sum of the Premium cost plus the Out-of-Pocket Maximum amount, to determine the most you could possibly pay in one year.

Terms	Colby SHIP (Wellfleet Insurance)	Considerations for Other Plans
Premium	$2,493 Annually	Consider the annual or monthly cost to pay for your plan.
Copayment	$0 (except for some prescription medications)	Some plans charge copayments for each medical visit (such as $10-$50 per visit), in addition to copayments for prescriptions.
Coinsurance	For most in-network health services, 80% of the cost is covered, with 20% of the cost remaining for the patient to pay.	Consider what percentage you will be expected to contribute out-of-pocket for each medical service.
Deductible	$0	Some plans may have a lower premium cost, but a higher deductible amount, that will need to be paid out-of-pocket by the patient first, before the insurance plan will begin covering the cost of care.
Out-of-Pocket Maximum	$2,350 for in-network health services	Some plans can have much higher out-of-pocket maximums.