Q. What is the Marketplace and what impact does it have on me?
A. the Marketplace is where individuals may go to purchase health insurance. The Affordable Care Act (ACA) requires, with few exceptions, individuals to have health insurance. Under ACA, individuals who don’t have health insurance beginning Jan.1, 2014, may have to pay a federal tax penalty. These penalties grow each year. Your SMU Student Health Insurance Plan (SHIP) meets this requirement, so you will not pay a penalty.
Q. Does the Student Health Insurance Plan sponsored by SMU qualify as health insurance under the new federal law?
A. Yes, the SMU Student Health Insurance Plan meets the ACA requirements and provides all mandated benefits.
Q. Can I buy the SMU Student Health Insurance Plan in the Health Insurance Marketplace and get a premium tax credit or cost-sharing assistance?
A. No, you cannot buy the SMU Student Health Insurance Plan on the Marketplace, nor can you get a premium tax credit or cost-sharing assistance for the SMU Student Health Insurance Plan. Student plans under ACA are treated separately because the cost of coverage and benefits reflect the student population and should be more affordable than many of the individual plans on the Marketplace.
Q. Aren’t some of the individual plans on the Marketplace supposed to be low or no cost if I qualify for a premium tax credit or cost-sharing support based on my income?
A. There may be low-or no-cost choices if you qualify for assistance based on earnings, but the Marketplace plans may not offer the same level of benefits you get on the SMU Student Health Insurance Plan. In other words, even though the monthly cost for an individual plan could be less, the amount you pay if you need services could be higher due to higher deductibles and higher coinsurance.
Q. What is the benefit of the SMU Student Health Insurance Plan compared to the individual plans on the Marketplace?
A. With the SMU Student Health Insurance Plan, you have the benefit of having an insurance plan that the University endorses that will cover 80 percent of eligible services with no deductible at the student health center(s) on campus.
This gives you easy access to basic health care services along with office visits, prescriptions and many preventive services at a low out-of-pocket cost. Also, if you need to see a doctor off-campus, you have the assurance of the comprehensive network of doctors, hospitals and specialists provided by Blue Cross and Blue Shield of Texas. The SMU Student Health Insurance Plan network list may be greater than the network list you would have on a Marketplace plan and is made up of providers across the nation and worldwide through our BlueCardSM program. The SMU Student Health Insurance Plan includes global emergency services, (evacuation, repatriation and AD&D coverage) which are valuable to students traveling abroad.
Q. What level of plan on the Marketplace will be accepted for a waiver by SMU?
A. The plan must be gold or platinum.
Q. What benefits are required to be covered on a plan purchased in the MarketPlace?
A. The plan must have coverage in the state of Texas. Many Gold or Platinumplans with the lowest rates (although often still greater than SHIP) are either HMO’s or EPO’s that have very limited networks which likely will not cover you at home or school. It must have a maximum annual deductible of $2500.00 or lower. It must also include the following benefits: emergency care, comprehensive in- and out-patient hospital care, physician office visits (prior to meeting deductible), pharmacy benefits (prior to meeting the deductible), mental health parity benefits (in and outpatient) and out-patient diagnostic coverage. The plan must not require that you meet the plan deductible before it pays for office visits, prescriptions, labs or simple x-rays.
Q. Are the enrollment periods the same for insurance with the SMU Student Health Insurance Plan as it is in the Marketplace?
A. Open enrollment periods do not necessarily coincide with the academic semester meaning students may be uninsured at points during the year.