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

Individuals with coverage | Issues For Young Adults: Student Health Plans and Coverage on Parent’s Health Plans |

It does if it is a “fully insured” student health plan, which most student health plans are. 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 drug
  • 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. (45 C.F.R. § 147.145).

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