When considering how to reduce the high insured rates of young adults, college students deserve special attention. This population alone has access to student health insurance plans that are generally offered through colleges to students. Student health insurance plans are insurance products offered by commercial carriers that have contracted with colleges to make coverage available to some or all of their students. Student health insurance plans, which are separate from accident-only policies, are offered by most colleges in addition to routine medical services that may be provided at a reduced cost through a health center on campus.
This unique vehicle through which students can obtain coverage could be one way that coverage is expanded in this population. Before efforts to expand this market may be considered, more information is needed about the relatively unexamined subjects of uninsured
To collect data on uninsured college students and student health insurance. TDI conducted four surveys, each intended to evaluate the topic from a different perspective. The surveys included:
- A survey of most student health insurance policies sold through
colleges and universities. TDI catalogued plan components from student health insurance plans offered at 65 Texas colleges and universities during the 2004-2005 academic year. Texas
- A survey of current
college students. TDI surveyed over 2,500 college students on nine campuses across the state in February and March of 2005. In addition to collecting demographic information, the survey asked students whether or not they had insurance coverage and through what means they obtained coverage or why they lacked coverage. Texas
- A survey of
college and university administrators. From August to November 2004, TDI surveyed Texas colleges to determine how many offer a student health insurance plan to students. This survey also collected data on the extent of college-level requirements that some or all students have health insurance coverage as a condition of enrollment. Texas
- A survey of insurance carriers writing student health insurance in
during the 2004-2005 academic year. This survey collected data on the experience in the student health insurance market and the number of lives covered by these plans. Texas
Student Health Insurance Policies in
· The average cost for student-only coverage in a student health insurance plan in
· Student health insurance policies tend to have limited benefits and multiple exclusions when compared to employer-sponsored coverage.
· About one-half of policies offered in
· Most policies offer limited catastrophic coverage. The most frequent catastrophic coverage limit was $50,000 per accident or illness.
· Three-fourths of
· Two-thirds of policies offer some coverage for inpatient and outpatient mental health, but most limit this coverage. Common limitations to inpatient mental health coverage include $3,000 per year and 30 days per year. A common limitation placed on outpatient mental health care is coverage for $50 per visit up to a maximum of $500 per year.
· Policies generally exclude pre-existing conditions for the first 12 months if the student lacked prior coverage.
· More than one-half of policies contain exclusions for routine exams and preventative care, injuries obtained while under the influence of alcohol or drugs, injuries resulting from “high risk” activities such as skydiving or bungee jumping, injuries from fighting except when in self defense, self-inflicted injuries including attempted suicide, elective abortions, and organ transplants.
Insurance Coverage and
- An estimated 36 percent of students attending public colleges are uninsured and 23 percent of students attending private colleges are uninsured.
- In general, students with the highest risk of being uninsured include non-traditional aged students, single parents, Hispanic students, students not in good health, students not required to have coverage by their college, students whose education is primarily financed by the military, and students in their senior year.
- In general, students with the greatest chance of having insurance coverage include those whose education is primarily financed by their parents, those required to have insurance by their college, PhD. students, students who work full-time, and married students with no dependent children.
- Seventy-eight percent of surveyed college students said that health insurance coverage is very important, 20 percent said it is somewhat important, and only two percent reported thinking that coverage is not important.
- About one-half of all students surveyed indicate a willingness to pay up to $50 each month for coverage; however, only 38 percent of uninsured students would pay more than $50 a month for coverage.
- Thirty percent of uninsured students lacked coverage for more than three years, and 30 percent of uninsured students had lacked coverage for less than one year.
- Seventy-one percent of uninsured students said they lacked coverage because it was too expensive.
- Fifty-four percent of uninsured students said they did not buy the school-sponsored student health insurance plan because it was too expensive, and 36 percent reported not knowing about the plan.
Plans Offered by Texas Colleges
- Sixty-three percent of
colleges reported offering a student health insurance plan. Texas
- Health-related institutions and public universities are more likely to offer a student health insurance plan than private colleges or junior colleges.
- No college reported difficulty finding a carrier that would provide coverage to their students.
Coverage Requirements for Students
- Few colleges in
require all students to have insurance coverage as a condition of enrollment, but that trend is growing nationwide. Texas
- 12 percent of
colleges reported requiring all students to have coverage, 61 percent require certain students to have coverage and 27 percent do not require coverage for any student. Texas
- Of the 12 colleges that reported requiring all students to have health insurance coverage, seven are health-related institutions, and the other five are private colleges.
- Almost all public universities in
only require international students to have health insurance coverage. Coverage is voluntary for all other students. Texas
Plan Enrollment Rates
- In general, enrollment in student health insurance plans in
is relatively low. The average enrollment rate in fall 2003 was 11 percent of the student body and the median enrollment rate was just six percent of the student body. Texas
- Enrollment rates are highest at health-related institutions. Enrollment rates at private colleges are higher than those at public colleges.
- The median enrollment rates at colleges which require students to have coverage is 29 percent.
- The ability to pay for coverage as part of tuition and fees and the requirement that students must accept or reject coverage during registration are both linked to higher plan enrollment rates.
- Enrollment in plans drops over the summer. In 2003 and 2004, enrollment dropped 12 to 15 percent from the spring semester to the summer semester. The decline is due in part to an insurer provision that requires students to be enrolled in summer classes to purchase coverage at the beginning of the summer term.
Student Health Insurance Market
- At least ten carriers wrote student health insurance during the 2004-2005 academic year. Of these, five have been in the
student health insurance market two years or less, and four have been in for ten years or more. Nine of ten carriers in the Texas market indicated they were considering expanding business. Texas
- Total student health insurance premiums written in 2003 for the seven companies writing were $22,200,000. Total claims paid were $19,500,000.
- In 2003, the market was relatively concentrated in two companies. The largest accounted for 59 percent of written premiums, and the second largest carrier wrote 22 percent of total premiums.
- Insurers reported covering 56,000 lives in student health insurance plans at any time in 2003, and they covered 37,500 lives on
September 15, 2004.
Conclusions and Policy Options
School-sponsored, student health insurance plans provide insurance coverage for tens of thousands of college students in
Students can benefit from school-sponsored plans that are designed to integrate with health services offered on campus, and students in less than perfect health can greatly benefit from the prohibition of medical underwriting in these plans. From an enrollee’s perspective, the limitations of these plans may include affordability issues, relatively low benefit levels compared to employment-based group plans, multiple exclusions, limited eligibility for part-time students, and limited accessibility over the summer.
If an expansion of the student health insurance market is deemed desirable, options exist at both the college-level and state-level to expand coverage to uninsured college students through student health insurance plans. More students could be encouraged to take advantage of coverage through these plans by policies that address more effective plan promotion, increasing accessibility and affordability of coverage, increasing the size of insured pools, adjusting coverages, increasing communication between colleges and providing more education to students on the value of health insurance protection. Crafting public policies that expand coverage to uninsured college students and achieve an appropriate balance of affordability, adequacy and accessibility for student health insurance plans will prove challenging but could result in benefits to students, colleges and the State of
In 2001, the Texas Department of Insurance (TDI) was awarded a State Planning Grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services to collect data on the uninsured population in
In 2003, TDI was awarded supplemental grant funds to extend its research on methods to expand health insurance coverage. The additional funding was used to evaluate the effectiveness of policies implemented in 2003, as well as to expand research into areas of opportunity identified under the original grant. One such area that became a focus of research under the supplemental grant was the uninsured college population and college-sponsored, student health insurance. Prior to this study, little information had been compiled on student health insurance in
The following report summarizes the research, findings, and policy options generated under TDI’s year-long investigation into the circumstances under which
Chapter 2 defines student health insurance plan coverage and explains how it differs from other health insurance products. An overview of the plans that are currently offered through colleges and universities in
Chapter 3 discusses the results of a survey of more than 2,500
Chapter 4 presents findings from a statewide survey of colleges and universities about student health insurance plans offered through colleges to students. This chapter provides data on how many colleges make such plans available and how that differs between four-year public universities, private colleges, junior colleges, and medical schools/health-related institutions. This chapter also provides information on how many colleges have policies requiring some or all students to have health insurance coverage and which students are subject to those requirements.
Chapter 5 provides the enrollment rates in school-sponsored health insurance at
Chapter 6 presents findings from a survey of carriers that write student health insurance coverage in
Finally, Chapter 7 discusses the limitations and benefits of student health insurance that were identified over the course of TDI’s research. Based on ideas and data discussed in the previous six chapters, this chapter provides a list of policy options intended to expand health insurance coverage to more Texas college students through student health insurance plans.
Young adults aged 18 to 24 are in the age range at the highest risk of being uninsured in
The Uninsured Young Adult Population in
Multiple factors explain why 18 to 24 year olds are particularly susceptible to being uninsured. The life transitions experienced by young adults both leave this age group vulnerable to losing insurance coverage and cause them to have unstable insurance coverage. Children covered by public insurance often lose their eligibility when they reach adulthood. Children covered under the Children’s Health Insurance Program (CHIP) in
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Percent Uninsured within Age Group
Percent of Total Uninsured Population
0 – 6
7 – 17
18 – 24
25 – 34
35 – 44
45 – 64
65 and over
Source: Texas Department of Insurance, Working Together for a Healthy Texas: Interim Report of the Texas State Planning Grant (Austin, Tex.,
Young adults in many states risk losing coverage through their parents on their 18th or 19th birthday unless they are enrolled in college full-time. A 2004 national survey of employer-sponsored health plans found that nearly 60 percent stop covering 18- or 19-year-old dependents who are not enrolled in college.
Young adults are also less likely to have access to employer-sponsored health insurance than older adults. This is especially true of young adults that do not go to college. Often, when young adults join the labor force, they work in jobs that are the least likely to offer health insurance coverage. Even young adults that can access insurance through their employers may not be able to afford the required premiums, and they remain at risk of unstable coverage because younger workers tend to change jobs more frequently than older workers.
Population Uninsured College
Nationally in 2002, 19 percent of full-time college students were uninsured, which was nearly 4 percentage points higher than the national uninsured rate. Also, in 1999, 29 percent of part-time college students lacked insurance. Among young adults that graduated from high school from 1996 to 2000 and enrolled in college, 23 percent lacked health insurance at some point during their freshman year in college. Estimates of the total uninsured rate among all college students range from 25 percent to 33 percent.
How College Students Access Insurance
The majority of non-elderly Americans obtain health insurance coverage through an employer. Nationally in 2003, 62 percent of the non-elderly had employer-sponsored health insurance coverage. Most college students are able to access insurance in two ways many other adults cannot. First, many college students can remain covered by a parent’s employer-sponsored health insurance. Second, most colleges and universities make student health insurance plans available to their students. This school-sponsored coverage provides a unique vehicle through which college students can access health insurance coverage. One-quarter of students are covered under either school-sponsored plans, an individual plan or a public health plan, including private individual plans, school-sponsored student health insurance, and public health insurance. Almost one-half of full-time college students have employer-sponsored insurance coverage as a dependent, and an additional 7 percent have employer-sponsored insurance from their own employment.
Benefits of Health Insurance for College Students
In general, college students tend to be relatively healthy, yet health insurance can provide many benefits to this population. Insurance coverage can help students meet their health care needs, especially when such care involves services not available on campus. For example, students may access primary care for the treatment of common infectious illnesses and sexually transmitted diseases. Regular preventive care is important to students, especially female students, for whom annual Pap smears are recommended once they reach age 18. Mental health care is increasingly important for college students. A study by the American College Health Association found that almost one-half of college students had trouble functioning at some point in college due to feelings of depression. In addition, stress, eating disorders, drug and alcohol abuse, and thoughts of suicide are all conditions for which college students frequently need access to mental health care.
Health insurance protects students and their families from high medical costs associated with serious injuries or illnesses. Though generally healthy, traditional-aged college students need access to acute care. In 2002, the leading cause of death among 15 to 24 year olds was unintentional injury. As seen in Table 1.2, young adults ages 18 to 24 are much more likely to have injury-related emergency room visits than older adults or children. From 2001 to 2002, 14 percent of all injury-related emergency room visits were made by 18 to 24 year olds.
Injury-Related Emergency Room Visits per 10,000 Persons
by Age and Gender, 2001-2002
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Under 18 years
65 years and over
Students that lack health insurance coverage may have difficulty accessing necessary care. A survey of uninsured young adults ages 19 to 29 found that they were more than twice as likely as insured young adults to say that they “would wait as long as possible to seek care when sick.” Additionally, 56 percent of uninsured young adults reported foregoing needed health care because of costs, compared to 33 percent of young adults with insurance coverage. Keeping continuous coverage during college will also help students access care after they graduate. Assuming a graduate maintained continuous insurance coverage in the year prior to graduation and takes a job that offers health insurance without a break in coverage of more than 63 days, he or she will not have any pre-existing conditions excluded during the first year of job-based coverage.
Finally, health insurance coverage during college will help teach students about health insurance and its value. College years often serve as a transition from dependence to independence, and a time when students begin to take on adult responsibilities. During their college years, students are likely to assume a more direct role in seeking and paying for medical care, and in doing so, will be made aware of the high costs of medical care and prescription drugs. Having and using insurance coverage during this time will give students a better understanding of and appreciation for the importance of coverage, and may increase the likelihood that they will continue to remain insured upon entering the job market.
There is a growing trend at colleges and universities nationwide to require all college students or full-time college students to have health insurance coverage. Most colleges do not specifically require participation in the school-sponsored plan, but they make such coverage available to students who do not have insurance through their parents or some other means.  The American College Health Association, an advocacy and education organization for college and university health programs, recommends that colleges require their students to provide proof of health insurance coverage as a condition of enrollment. For the most part, colleges in
Types of Student Health Insurance Requirements
Student health insurance requirements range from fully voluntary to fully mandatory. A fully voluntary plan does not require any student to have coverage, and any student who wants coverage purchases it directly from the carrier. A forced answer system is next on the continuum. Under this system, students are still not required to have coverage, but they are required to either accept or reject insurance before school registration can be completed. If a student accepts coverage or fails to reject it, premiums are added to the tuition and fee bill.
Under mandatory systems, some or all students are required to have coverage as a condition of enrollment. Often, mandatory systems let students waive school-sponsored coverage if they have alternate coverage through their parents, their spouse, a job, etc. A request for a waiver must be returned by a certain date with the required proof of coverage or the student is automatically enrolled in the school-sponsored plan. A loose waiver system only requires students to attest that they have alternate coverage by signing a form or checking a box. A hard waiver system requires students to submit specific proof of coverage, often a copy of an insurance card, with their waiver application. Finally, a few colleges mandate coverage in the school-sponsored plan for some or all students. Under this system, students are automatically enrolled in the student health insurance plan and cannot be granted waivers if they have alternate coverage.
States and College Systems with Coverage Requirements
Currently three states -
The statute requiring college students to carry health insurance in
In 1991, the New Jersey Legislature passed legislation requiring all full-time students in public and private institutions of higher education to have health insurance coverage. In addition, it required all institutions of higher education to make student health insurance plans available to their students. The law also requires colleges to take the costs of health insurance into account when determining eligibility for financial aid. If students have alternate health insurance coverage, they must present proof of it to their school annually to receive a waiver from the school-sponsored coverage.
In 2002, the Idaho Board of Education implemented regulations requiring public, four-year universities to offer student health insurance and all full-time students at such institutions to maintain health insurance coverage. Colleges may allow students to waive the school-sponsored plan if they provide proof of equivalent alternate coverage. Additionally, colleges must monitor and enforce this requirement.
Requirements in Large University Systems
In several states that do not have state laws requiring student health insurance coverage, the governing boards of public university systems have adopted such requirements. In 2000, the
Certain international students are required by federal law to have health insurance coverage in effect while they are studying at colleges in the
Reasons for Insurance Coverage Mandates
There are multiple reasons why states and colleges have adopted student health insurance coverage requirements. One primary reason is to address high uninsured rates and related problems on college campuses. The
Another primary reason that colleges have chosen to require health insurance coverage is to increase the viability of their insurance plan. If all students are required to have coverage, adverse selection will be avoided and risks will be spread over a bigger pool of students. These factors should improve the experience of the plan and allow for lower premiums and/or expanded coverage. Voluntary plans tend to have more exclusions and lower benefit levels. In many cases, voluntary student health insurance plans remain viable because international students, who are required to carry insurance, indirectly subsidize coverage for domestic students that opt in. Additionally, if a student is subject to an insurance requirement, the cost of a student health insurance plan can be included in calculations to determine financial aid, making coverage more affordable for students.
Despite the fact that the college population is relatively young and healthy on average, health insurance coverage offers important protections to this population. Unfortunately, many college students lack health insurance. High uninsured rates among college students present many challenges both for uninsured students and the larger college community. Some colleges and states are attempting to address these problems by requiring coverage for students. While such requirements are not the only option available to colleges and states attempting to combat high uninsured rates on campuses, they are becoming more common.
Colleges often offer school-sponsored health insurance to students for the same reasons many offer health care on campus – they have an interest in maintaining the health of their student body so students can achieve their educational objectives. College students, like other young adults, can easily fall through the cracks when it comes to accessing coverage. This is especially true if a student’s parents do not have employer-sponsored health insurance coverage. To mitigate some of the difficulties students face in accessing coverage, many colleges and universities offer student health insurance plans. This chapter defines student health insurance plans, describes components of plans sold in
Student health insurance plans are insurance products offered by commercial carriers that have contracted with colleges, which in turn make coverage available to some or all of their students. The plans, which are different from accident-only policies, are offered by most colleges in addition to any medical services that may be provided at a reduced cost through a health center on campus. Individual colleges or college systems select an insurance carrier with which to contract, generally as part of a bid process. The college often plays a role in determining plan components; therefore, the level of coverage and cost of these plans varies greatly across colleges. Some colleges offer comprehensive plans that compare favorably to employer-sponsored insurance in terms of benefits; however, others offer coverage inadequate even to meet the needs of the traditionally healthy college population. In
In 2000, the American College Health Association (ACHA) released an updated version of Standards for Student Health Insurance/Benefit Programs, which is meant to guide institutions of higher education in the development of quality student health insurance plans. One of the ten standards instructs colleges to design a plan with the knowledge “that students rely upon its student health insurance/benefit program for their primary source of health insurance protection,” and thus, provide “an appropriate scope of coverage.” To provide such coverage, the guidelines recommend a plan have a minimum level of benefits that cover preventative health care, mental health care, and catastrophic illness and injuries.
Stephen L. Beckley, a health care benefits consultant who specializes in higher education and one of the four members of the ACHA committee that drafted Standards for Student Health Insurance/Benefit Programs, has defined appropriate coverage in student health insurance plans in more specific terms. He asserts that components of a student health insurance plan, including covered benefits, definitions, limitations and exclusions, should be consistent with those generally found in large, employer-sponsored health insurance coverage. Mr. Beckley estimates that more than 85 percent of the student health insurance plans found at colleges nationwide fail to comply with the ACHA guidelines.
The following section presents many of the components of student health insurance plans in general as well as the range of options and coverage found in plans offered by institutions of higher education in
Unlike in the individual health insurance market, medical underwriting is not used in student health insurance plans. Colleges and universities that receive any federal funding are prohibited by Section 504 of the Rehabilitation Act of 1973 from discriminating against any student based on a handicap. As it relates to student health insurance, this law prohibits denying coverage based on a health condition or basing premiums on health status. This is an advantage for students with chronic conditions who may be uninsurable in the individual market. No student health insurance plan offered through a college in
Eligibility requirements for student health insurance vary by school. Some plans extend eligibility to any student who is registered and attending classes, but more limited eligibility structures are common. One of the most common restrictions limits enrollment to students that are registered for a minimum number of hours. Another common restriction excludes students that are only registered in online or correspondence classes. Many plans allow covered students to enroll their dependents as well. Though the ACHA guidelines do not specifically address student eligibility, they state that covered students should be allowed to enroll their spouse or domestic partner and children.
With few exceptions, plans in
All but a few
Student health insurance plans generally provide several options regarding the length of time for which coverage can be purchased. Almost every plan offers enrollment periods that correspond generally with the fall, spring, and summer semesters. Nearly 60 percent of plans offer students the option to purchase spring and summer coverage together in January, and about one-third of plans lack a spring-only option so that students must buy spring and summer coverage together. Students must meet the eligibility criteria each time they enroll, so the ability to buy spring and summer coverage together allows students who are not taking summer classes to remain insured.
About three-fourths of plans also offer students the option to purchase coverage for the entire academic year (September through August) in the fall. An annual enrollment option provides the benefit of continuous coverage for twelve months, but the entire year must be paid for up front. In addition to semester enrollment periods, a number of plans offer students the option to purchase coverage quarterly and a few allow students to buy coverage on a monthly basis. A student that purchases coverage for shorter periods of time may be more at risk of intermittent coverage if he or she takes a semester off or simply forgets to renew coverage.
Integration with Campus Health Services
One of the benefits of student health insurance plans is that they often integrate with and fully cover services delivered at the health center on campus. For example, mental health benefits can supplement services provided at student counseling centers. Plans can also cover charges for fee-for-service treatment at the student health clinic. Many plans waive deductibles and co-payments for services obtained at the student health center. In addition, such services are often covered 100 percent, while coinsurance would apply to medical services obtained off-campus. ACHA guidelines recommend a plan design that “encourages utilization of campus health and counseling services, where doing so provides cost effective and high quality care for students.”
Approximately one-third of student health insurance plans in
Catastrophic Coverage and Maximum Benefits
Unlike employer-sponsored health insurance plans, the maximum benefit in student health insurance is generally applied per injury or illness as opposed to a lifetime maximum. Many school-sponsored plans offer a basic benefit with a relatively low per injury/illness maximum, and in addition, offer enrollees the option of purchasing additional catastrophic coverage. This optional coverage may increase the basic maximum benefit three or four times.
All plans in
Approximately one-third of plans in
Fewer than 20 percent of plans in
Cost sharing is common in the student health insurance plans found in
Outpatient prescription drug coverage varies considerably among student health insurance plans. It is impossible to determine what level of coverage is adequate in a plan without first considering whether a college has a pharmacy in its student health clinic and to what degree prescription drugs are discounted through the pharmacy. Approximately three-fourths of plans in
Title IX of the Education Amendments of 1972, which prohibits gender discrimination at colleges that receive federal funds, requires student health insurance plans to cover pregnancy as any other temporary illness or disability. Plans must include this coverage not only for students, but also for a student’s enrolled spouse. Maternity coverage is treated very differently in the student health insurance market than the individual market, where such coverage is generally sold as a rider, and is expensive due to adverse selection. Materials from two-thirds of student plans offered in
Medical Evacuation and Repatriation
Most plans in
Other Covered Expenses
ACHA guidelines recommend that student health insurance plans have coverage sufficient to be the sole source of health insurance for students. Specifically, ACHA recommends that plans, at a minimum, have sufficient coverage for preventative health care, mental health care, and catastrophic illness and injuries. All student health insurance plans offered in
A few plans offer no coverage for emergency treatment, and only one-third of plans offer emergency treatment without limitations other than cost-sharing and plan maximum benefits. Two-thirds of plans offer some coverage for inpatient and outpatient mental health treatment, but more than four out of five limit the benefits. Common limitations to inpatient mental health coverage include $3,000 per year and 30 days per year. Outpatient mental health care coverage is commonly limited to $50 per visit up to a maximum of $500. Only one-quarter of plans include specific language about coverage for drug and alcohol abuse treatment.
Exclusions and Limitations
ACHA guidelines state that student health insurance plans should minimize pre-existing condition exclusions and waiting periods. The regulation of student health insurance plans in
Student health insurance plans tend to have multiple exclusions, many of which are for medical services that may be useful to the college population. Most plans reviewed exclude routine exams and preventative care; however, some plans make an exception for annual well-woman care. More than three-fourths exclude elective abortions and self-inflicted injuries, including attempted suicide. More than one-half contain exclusions for organ transplants, injuries obtained while under the influence of alcohol or drugs, injuries resulting from “high risk” activities such as skydiving or bungee jumping, and injuries from fighting except when in self-defense. Almost one-quarter of plans exclude inpatient mental health care and one-third exclude outpatient mental health care. More than one in six plans excludes outpatient prescriptions and three plans specifically exclude contraceptives. Ten percent of
Costs of Coverage
Premiums for Student Health Insurance Plans in
Premiums for student health insurance vary dramatically by plan and college, reflecting to some degree the level of coverage provided. The most expensive plans tend to be those with the most generous benefit structures, while the least-expensive plans do not provide major medical coverage . Nationally, student health insurance plans that comply with ACHA’s standards have average student premiums of $1,200 to $1,500 for 12 months of coverage. More than 80 percent of the plans available in
Dependent coverage is considerably more expensive than student coverage. Annual premiums for student and spouse coverage range from $558 to $8,246. The average annual premium for student and spouse coverage is $3,169. The median premium is $2,660, which is nearly four times the student-only median annual premium. Annual premiums for student and child coverage range from $138 to $4,104. The average student and child premium is $1,806 per year and the median is $1,690 per year.
Annual premiums for student, spouse, and child coverage range from $536 to $9,985; the average is $4,177. The median annual premium is $4,095, which is five times the student-only median annual premium. More than one-half of the student health insurance plans sold in
Distribution of Annual Student Premiums in
Student Health Insurance Plans - Student-only Coverage
Source: Analysis of plan materials for 37 school-sponsored student health insurance plans made available for the 2004-2005 academic year through 65 colleges and universities in the state of
Almost one-third of plans in
Two plans sold in
Cost Comparison to Other Health Insurance Products
Ideally, school-sponsored health insurance plans will provide affordable coverage to students that is a good value relative to coverage students may get in the group and individual health insurance market. In 2004, the average annual premium for an individual in an employer-sponsored group health insurance plan was $3,695, compared to an average of $775 for annual, student-only coverage in a
The comparison to family coverage in group health insurance is similar. The average annual premium for family coverage in an employer-sponsored, group health insurance plan was $9,950, compared to $4,177 for student, spouse, and child coverage in
Average annual premiums for individual health insurance are not as easy to estimate as employer-sponsored coverage. In most cases, premiums vary by an enrollee’s age, gender, and location and are dependent on which benefits the enrollee chooses to include and exclude. A study by the Kaiser Family Foundation and eHealthInsurance found that individual policies sold through eHealthInsurance in the first half of 2003 to 18 to 24 year olds in the south-central region of the United States had average annual premiums of $1,045 for single coverage and $1,590 for family coverage. Based on these estimates, average annual coverage for students is less expensive through school-sponsored plans in
Though they have much in common with other forms of health insurance, student health insurance plans are unique products designed to integrate with college resources and reflect the needs of college students. Few of the student health insurance plans offered in
Texas College Students Access to and
Attitudes about Health Insurance
In general, national surveys that collect data on the uninsured are ill-equipped to capture some data that is specifically relevant to the college population. For example, the Current Population Survey administered by the U.S. Census Bureau does not differentiate student health insurance plans offered through colleges from private, individual plans purchased directly from agents or companies.[lxxxvi] To craft policies that will reduce uninsured rates on college campuses, policymakers and college administrators will need to understand who uninsured students are and their barriers to accessing coverage in general and school-sponsored, student health insurance plans in particular. To meet this need for information, the Texas Department of Insurance (TDI) collaborated with campus officials across the state and gathered college-specific data as part of its first-ever survey of Texas college students.
Methodology of Student Survey
TDI worked with nine colleges and universities in Texas to survey current college students about health insurance. In December 2004 and January 2005, letters were sent from TDI to administrators at 16 Texas colleges inviting them to participate in the survey. Institutions recruited for this survey were chosen in order to assemble a diverse group in terms of size, type, and location. The nine colleges that ultimately participated in the survey were Baylor University, El Paso Community College, Midwestern State University, Southern Methodist University, St. Mary’s University, Texas State University, Texas Tech University, University of Texas-Austin, and University of Texas-Pan American. Each participating college, with the exception of El Paso Community College, offers a student health insurance plan.
The Texas Department of Insurance developed a web-based survey, the 2005 Survey of College Students' Health Insurance Coverage, which contained 22 questions about insurance coverage, attitudes about health insurance, and various demographic factors. The surveys were posted on TDI’s website, but they were not accessible without the specific link. Colleges were asked to send an email with the survey link and a request to take the survey to a randomly selected sample of at least 2,000 student email addresses, but the decisions on how to distribute the survey were left to individual colleges.
All colleges except the University of Texas-Austin (UT) sent the survey recruitment email to students from a college staff person. UT instead provided TDI with a list of 4,028 randomly selected student email addresses, and the survey recruitment email was sent from TDI. Four colleges opted to send the survey link to their entire student body. Exceptions included UT, Texas State, Texas Tech, El Paso Community College, and Baylor. Texas State and Texas Tech each emailed the survey link to approximately 2,000 randomly selected student email addresses. El Paso Community College emailed the survey link to the 1,346 students enrolled in their online learning program. Baylor was especially interested in gathering data on their graduate student population and chose to send the survey link to 2,000 undergrads in addition to all 2,015 graduate, seminary, and law students. A few colleges sent a follow-up email in addition to the original request to remind students about the survey.
All survey recruitment emails with the link to the survey were sent between February 1, 2005, and March 2, 2005. Surveying was completed at all colleges by March 17, 2005. The web-based surveys were available to students for at least two weeks following the day the students received the survey link. Response rates in general were predictably low, as the survey was completely voluntary and students were not offered anything in return for participating in the survey. Table 3.1 shows the approximate number of students to whom the survey request was sent and the number of survey respondents by college.
 For more information on all research and analysis activities undertaken as part of the original and supplemental State Planning Grants, go to www.tdi.state.tx.us/company/spg.html.
 Sara R. Collins, Cathy Schoen, Katie Tenney, Michelle M. Doty, and Alice Ho, Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help (
 Texas Department of Insurance, Working Together for a Healthy Texas: Interim Report of the Texas State Planning Grant (Austin, Tex., September 30, 2004), pp. 11-12. Online. Available: http://www.tdi.state.tx.us/general/pdf/spgint04.pdf. Accessed:
 Ibid., p. 13. Analysis by
 Collins et al., Rite of Passage?, p. 2.
 Center for Public Policy Priorities, Who Gets Health Care from Medicaid and CHIP in
 Sara R. Collins, Cathy Schoen, Michelle M. Doty and Alyssa L. Holmgren, Job-Based Health Insurance in the Balance: Employer Views of Coverage in the Workplace (
 House Bill 1440, 77th Texas Legislature, regular session (2001).
 Office of House Bill Analysis, H.B. 1440 77(R) Bill Analysis. Online. Available: http://www.capitol.state.tx.us/cgi-bin/tlo/textframe.cmd?LEG=77&SESS=R&CHAMBER=H&BILLTYPE=B&BILLSUFFIX=01440&VERSION=5&TYPE=A. Accessed:
 Collins et al., Rite of Passage?, pp. 3-4.
 Ibid., p. 3, Chart 5. Data from the 2001 Medical Expenditure Panel Survey. Analysis by Sherry Glied and Douglas Gould for the Commonwealth Fund.
 Texas Department of Insurance, Working Together for a Healthy Texas, p. 12 (online). Data from the March 2003 Current Population Survey.
 Kevin Quinn, Cathy Schoen and Louisa Buatti, On Their Own: Young Adults Living Without Health Insurance (
 Collins et al, Rite of Passage?, p. 4. Data from the 1996 Panel of the Survey of Income and Program Participation. Analysis by Pamela Farley Short and Deborah Graefe for the Commonwealth Fund.
 Sana Siwolop, “In Loco Parentis Doesn’t Necessarily Pay the Doctor,” New York Times, Late Edition (
 Collins et al, Rite of Passage?, p. 3, Chart 5. Data from the 2001 Medical Expenditure Panel Survey. Analysis by Sherry Glied and Douglas Gould for the Commonwealth Fund.
 John M. Dorman, “Sexually Transmitted Diseases among College Students,” in Principles and Practices of Student Health, ed. Helen M. Wallace, Kevin Patrick, Guy S. Parcel, and Judith B. Igoe (Oakland: Third Party Publishing Company, 1992), p. 688.
 Ted W. Grace and Kevin Patrick, “Common Infection Illnesses among College Students,” in Principles and Practices of Student Health, ed. Helen M. Wallace, Kevin Patrick, Guy S. Parcel, and Judith B. Igoe (Oakland: Third Party Publishing Company, 1992), p. 631.
 U.S. Department of Health and Human Services, Office on Women’s Health, Pap Test, July 2002. Online. Available: http://www.4woman.gov/faq/pap.htm. Accessed:
 Mary Duenwald, “The Dorms May Be Great, but How’s the Counseling?”, New York Times (
 Ibid. Table 84.
 Quinn et al., p. 6.
 Collins et al., Rite of Passage, p. 5. Authors’ analysis Commonwealth Fund Biennial Health Insurance Survey (2003) data.
 Associated Press, “More Colleges Making Health Insurance Mandatory,”
 Stephen L. Beckley and Associates, Inc., Student Health Insurance/Benefit Program Enrollment System Definitions, revised
 Siwolop, “In Loco Parentis,” sec. 3, p. 8.
 Stephen L. Beckley, Review of the
 114.6 Code of
 Massachusetts Division of Health Care Finance and Policy, “Qualifying Student Health Insurance Program Report, Fall 2002” (Excel spreadsheet).
 Ed Ehlinger, Sue Jackson, and Gary Christenson, “Institutional Requirement for Health Insurance for Students in Post-Secondary Education,”
 Code of Federal Regulation, Title 22, Section 514.14.
 The nine health-related institutions in Texas include: Baylor College of Medicine, Texas Tech University Health Sciences Center, The Texas A&M University System Health Science Center, The University of Texas Health Science Center at Houston, The University of Texas Health Science Center at San Antonio, The University of Texas M.D. Anderson Cancer Center, The University of Texas Medical Branch at Galveston, The University of Texas Southwestern Medical Center at Dallas, and University of North Texas Health Science Center at Fort Worth.
 Telephone interview with Stacey Silverman, Program Director, Texas Higher Education Coordinating Board,
 Texas House of Representatives, Higher Education Committee, Testimony on Senate Bill 505, 77th Texas Legislature, regular session (April 10, 2001), 0:01:20-0:36:09. Audio archive online. Available: http://www.house.state.tx.us/committees/audio77/290.htm. Accessed:
 Claire Vannette, “UC Students Charged for Mandatory Insurance,” The Guardian via U-Wire,
 Ehlinger et al., “Institutional Requirement for Health Insurance,” slide 12 (PowerPoint presentation).
 Ibid., slide 13.
 Ibid., slides 14-15.
 Telephone interview with Stephen L. Beckley, Higher Education Healthcare Management and Benefit Consultant, Stephen L. Beckley and Associates, Inc.,
 American College Health Association, Standards of Practice for Health Promotion in Higher Education, Second Edition, revised January 2005, p. 1. Online. Available: http://www.acha.org/info_resources/SPHPHE_statement.pdf. Accessed:
 There are some individual health insurance products that are sold to college students directly by agents or insurance companies but are not endorsed or sponsored by a particular college or university. For the purposes of this report, such plans are not considered student health insurance.
 Lynn Rosellini, “Health Care Headaches,” U.S. News & World Report, vol. 132, no. 12 (
 Stephen L. Beckley, Review of the
 Stephen D. Blom and Stephen L. Beckley, “6 Major Challenges Facing Student Health Programs,” The Chronicle of Higher Education, vol. 21, issue 21 (
 Institutions of higher education in
 The use of the word colleges or the phrase colleges and universities throughout this paper refer in general to all institutions of higher education.
 Plan materials were collected from college and plan websites, and additional plan materials were collected from colleges as part of TDI’s 2004 College and University Student Health Insurance Survey. Plans analyzed include those offered through: Alamo Community College District, Angelo State University, Baylor College of Medicine, Baylor University, Dallas Baptist University, East Texas Baptist University, Huston-Tillotson College, Lamar Institute of Technology, Lamar State College - Orange, Lamar State College - Port Arthur, Lamar University, LeToureau University, Midwestern State University, Odessa College, Our Lady of the Lake University, Prairie View A&M University, South Texas Community College, Southern Methodist University, Southwestern Adventist University, St. Edward's University, St. Mary's University, Stephen F. Austin State University, Tarleton State University, Texas A&M International University, Texas A&M University, Texas A&M University at Galveston, Texas A&M University System Health Science Center, Texas A&M University-Commerce, Texas A&M University-Corpus Christi, Texas A&M University-Kingsville, Texas A&M University-Texarkana, Texas Christian University, Texas Southern University, Texas State Technical College - Harlingen, Texas State Technical College - Marshall, Texas State Technical College - Sweetwater, Texas State Technical College - Waco, Texas State University, Texas Tech University Health Science Center, Texas Tech University, Texas Wesleyan University, Texas Woman's University, Trinity University, University of Dallas, University of Houston, University of Houston Clear Lake Campus, University of Houston Downtown Campus, University of Houston Victoria Campus, University of North Texas, University of North Texas Health Science Center, University of Texas - Pan American, University of Texas at Arlington, University of Texas at Austin, University of Texas at Brownsville, University of Texas at Dallas, University of Texas at El Paso, University of Texas at San Antonio, University of Texas at Tyler, University of Texas Medical Branch at Galveston, University of Texas of the Permian Basin, University of Texas Health Science Center-Houston, University of Texas Health Science Center-San Antonio, University of Texas M.D. Anderson Cancer Center, University of Texas Southwestern Medical Center Dallas, and West Texas A&M University.
 Stephen L. Beckley, Health Insurance Choice for College Students, updated
 American College Health Association, Standards for Student Health Insurance (online).
 The use of the phrase public university specifically refers to public, four-year universities or two-year, degree granting, senior colleges.
 The use of the phrase junior college throughout this report incorporates all forms of two-year colleges including state colleges, community colleges, and state technical colleges.
 Author’s analysis of plan materials for 37 school-sponsored, student health insurance plans in
 American College Health Association, Update: Implications of the Civil Rights Restoration Act of 1987 (online).
 Author’s analysis of plan materials for 37 school-sponsored, student health insurance plans in
 Code of Federal Regulation, Title 22, Section 514.14.
 American College Health Association, Standards of Practice for Health Promotion in Higher Education, Second Edition, revised January 2005, pg. 1. Online. Available: http://www.acha.org/info_resources/SPHPHE_statement.pdf. Accessed:
 Texas Insurance Code, Title 8, section 1251.108.
 Blom and
 All premium amounts in this report are given for 12 months of coverage offered according to an academic calendar year (September through August).
 Kaiser Family Foundation and the Health Research and Educational Trust, Employer Health Benefits 2004 Annual Survey (
 Kaiser Family Foundation and the Health Research and Educational Trust, Employer Health Benefits 2004 Annual Survey, pp. 2-3 (online).
 Kaiser Family Foundation and the Health Research and Educational Trust, Employer Health Benefits 2004 Annual Survey, pp. 2-3 (online).
 Kaiser Family Foundation and eHealthInsurance, Update on Individual Health Insurance, revised August 2004, pp. 4-5. Online. Available: http://www.kff.org/insurance/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=44678. Accessed: