Q: What do I need to know about my Group Health Insurance Program benefits before my student goes to college?
A. Sending kids off to college can be stressful and few parents send their kids off without worrying. Understanding your student’s health care benefits while away at college is an important consideration. Here is some information you should keep in mind:
If your student is attending school within your health plan’s service area:
If your Dependent is a full-time student attending school within your Health Plan’s Service area, meaning that network providers are available where they go to school, coverage will remain the same. They should seek care only from in-network providers unless it is an emergency or they need urgent care, which means care for an accident or illness which is needed sooner than a routine doctor’s visit.
If your student is attending school outside your health plan’s service area:
If your Dependent is a full-time student attending school outside of your Health Plan’s Service Area, that is, there are no plan providers near their school:
- Urgent Care and Emergency Room services will be covered by your health plan as if they were in-network.
- After the Urgent or Emergency Room visit, if your Dependent requires follow-up care to manage an illness or injury, in most cases, they will be required to return to your health plan’s service area (unless enrolled in the Access Plan).
- Some limited exceptions might be granted if your dependent is physically unable to return to the service area and care is medically necessary. Contact your health plan.
- Health plans may provide written prior authorization on a case-by-case basis for any follow-up care that is received from an Out-of-Network Provider.
Mental health and substance use disorder services
- Certain outpatient mental health services and treatment of alcohol or drug abuse will be covered as Out-of-Network as described below. Contact your plan if such care is needed.
- Your dependent may have a clinical assessment by an Out-of-Network Provider with Prior Authorization in writing from your Health Plan.
- If outpatient services are recommended, your Dependent will be allowed coverage for five visits outside of the Service Area with Prior Authorization from your Health Plan. Your Health Plan may approve additional visits.
- If your student Dependent is unable to maintain full-time student status, they must obtain services from an in-network Provider for treatment to be covered unless you are enrolled in the Access Plan or other PPO Plan.
Note: ETF offers nationwide and international coverage through the Access Plan, administered by Dean Health Plan. You may select the Access Plan during the open enrollment period effective January first of the next year, or sooner if you have a qualifying life event.
If your student is attending school outside the United States
- The Access Plan will cover claims outside of the United States as Out-of-Network unless it’s emergency or urgent care. Those services are allowed at the in-network level of benefits. You will have to pay the claim then have it translated into English (if necessary) then submit it to the Access Plan administrator, Dean, for reimbursement.