Tulane's student health insurance

Colleges and Universities A-Z Tulane University
1

<p>Does any one here have experience with buying and using the health insurance through Tulane? Is it adequate coverage and is the cost appropriate for what the coverage is? </p>

<p>My D will be 18 on Saturday. She has had some major health issues with the ensuing preexisting conditions. She is currently on our state Medicaid coverage and will be on that until she is 19, at which time she can be added to my family plan through my employer. She can not be added to my employers family plan until she is kicked off medicaid in a year.</p>

<p>Is out of state medicaid sufficient, should we purchase the Tulane sponsored insurance, or look for private insurance that may or may not cover her preexisting conditions?</p>

<p>Thanks,</p>

<p>B.</p>

2

<p>bajamm:</p>

<p>We didn’t buy the Tulane insurance for our freshman daughter. Tulane’s policy is through Aetna. If you D has some major health issues that could become active while at college, then you should be aware that the Aetna policy has a maximum benefits that are lower than found in a typical employer sponsored insurance plan. (Medicaid plans typically have no maximum benefits, per se, but pay for any services that are covered in the State Plan and are medically necessary.) The following passage from the Aetna brochure gives an overview of these limits:</p>

<p>“This Plan will never pay more than $250,000 per condition per Lifetime; more than $250 per visit per Policy Year for a Consultation or Specialist expense; or more than $2,250 per Policy Year for Prescription Drugs.”</p>

<p>Here is a link to the current policy brochure, on line:</p>

<p><a href=“http://www.aetnastudenthealth.com/schools/tulane/brochure1011.pdf[/url]”>http://www.aetnastudenthealth.com/schools/tulane/brochure1011.pdf&lt;/a&gt;&lt;/p&gt;

<p>Every state’s Medicaid program is different. I would suggest that you inquire of the state agency that runs your Medicaid program about what coverage is available for Medicaid recipients who live out of state. For example, Section 51006 of Title 22 of the California Code of Regulations (which governs out of state coverage for Medi-Cal) states:</p>

<p>(a) Necessary out-of-state medical care, within the limits of the program, is covered only under the following conditions:</p>

<p>(1) When an emergency arises from accident, injury or illness; or</p>

<p>(2) Where the health of the individual would be endangered if care and services are postponed until it is feasible that he return to California; or</p>

<p>(3) Where the health of the individual would be endangered if he undertook travel to return to California; or</p>

<p>(4) When it is customary practice in border communities for residents to use medical resources in adjacent areas outside the State; or</p>

<p>(5) When an out-of-state treatment plan has been proposed by the beneficiary’s attending physician and the proposed plan has been received, reviewed and authorized by the Department before the services are provided. The Department may authorize such out-of-state treatment plans only when the proposed treatment is not available from resources and facilities within the State.</p>

<p>(6) Prior authorization is required for all out-of-state services, except:</p>

<p>(A) Emergency services as defined in Section 51056.</p>

<p>(B) Services provided in border areas adjacent to California where it is customary practice for California residents to avail themselves of such services. Under these circumstances, program controls and limitations are the same as for services from providers within the State.</p>

<p>(b) No services are covered outside the United States, except for emergency services requiring hospitalization in Canada or Mexico.</p>

<p>So you can see that the coverage for a California resident with Medi-Cal, attending college in Louisiana, would be tenuous. Moreover, I believe that the medical insurance waiver form that Tulane students with existing insurance complete (in lieu of purchasing the Aetna policy) has language to the effect that the existing insurance must cover more than just emergency services. Suggest that, after finding out to what extent your state’s Medicaid program covers out of state services, you relay this information to Tulane Health Service to make sure that it is even possible for your daughter to submit the waiver.</p>

<p>If you do purchase the Aetna policy or another private policy (which might be prohibitively expensive, with pre-existing conditions), then your state’s Medicaid program is going to consider that policy to be “primary”. Medicaid programs always think of themselves as the “insurers of last resort” and most have aggressive third party liability recovery programs. Expect many administrative hassles as the two insurers (Medicaid and the insurance you purchase) tangle.</p>

<p>Sorry to be a bit of a downer on this answer, but our health system is pretty messed up and situations like your daughter’s make its faults very evident. The good thing is that you only have to worry about this during her freshman year, since you say that subsequently she can go on your policy. Hope that she stays well next year and this discussion proves to be purely academic.</p>

3

<p>Thanks, capandgown, for your answer! That is what I needed to hear. And, about what I expected. I will check into our states medicaid coverage for out of state, though won’t be surprised if it is about like California’s.</p>

4

<p>bajamm, one other thing you might check is if she will still be able to go onto your plan if she is on the Tulane Plan – in your first post you indicate that your employers plan will only pick her up once she is kicked off the state plan, but will they consider this going off voluntarily?? I don’t know, and I don’t want to suggest that this will happen, just trying to think of any future implications.</p>

5

<p>Any military or former military members in this group with dependent students at Tulane?I’m exploring the Health Insurance issue relating to the waiver as S is covered under the Military Tri-Care Prime Program (albeit in another region). Appreciate any input.</p>