How to keep health insurnace for a struggling college student

September 26, 2009 8:55 AM

We struggling to keep our over-18 child covered under our health insurance. She has a four year history of mental health struggles. She has been able to more or less stay in school as a full-time student but we aren't sure she can keep it up. The two strategies seemed to be to get the school to give her full-time status with a partial load due to disability or to convince the insurance company that she is not capable of "self-sustaining employment" Anyone have any experience with either route?

Four years ago, our child got hit with major depression. There were two hospitalizations, intensive counseling and medication. Things are better than they were and she choose to go off to college with a sheaf of prescriptions, a new therapist lined up and an IEP to help reduce stress and accomodate ups and downs.

She struggled through fall semester with the minimum full-time load at a four year college. With several incompletes, she finally ended up with a D average. At the recommendation of the school she took off spring semester but took a full-time load in the summer. She did better (a C average). She has also had non-stop physical complaints (some physical, some psychosomatic). She decided to return home and go to community college. Three months of FT school in the summer plus four months in the fall should maintain her status as a FT student for the year. (per my reading of IRS regulations). However, school started on Monday and she is falling apart. At this point, I don't think she can handle a full-time load - I'm hoping for half-time.

So our insurance covers children after 18 if they are either full-time students or if the company determines that they are disabled based on (a) are a dependent for federal taxes purposes and (b)"incapable of self-sustaining employment" (This child's last job was as a summer camp CIT before her problems began.)

I've heard some people work with the school so that the IEP includes a condition that a lighter load counts as "full time" and that the insurance companies will accept that. Does it work? I'm afraid to ask anything to insurance company for fear they will cut her off.

With my older child, the insurance company just asked if she was a student but never required verification. However, since this child has huge medical bills, I don't want to take any chances.

How likely is an insurance company to accept her as transitioning from full-time student to disabled when the disability began four years ago? Since this is based on a mental illness and she has been sort of holding it together, has anyone had experience with this scenario?

By the way, our insurance is a fairly good plan administered by United Healthcare. The local school does not offer any student health insurance and given her claim history (doctor visits almost every week or more, not counting psych care), no company would write her an individual policy unless they had to do so.

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posted by anonymous to health & fitness (16 comments total)

Hi, anon. I sent an e-mail your way.
posted by Zosia Blue at 9:12 AM on September 26

From a legal viewpoint, if she is registered with the Disabled Students Program and is taking a reduced course load based on disability, she should "count" as a full-time student. BUT -- insurance companies often operate in their own wild wild west. Perhaps call the DSP and ask if they've had that situation? Maybe they can see if another parent would talk to you?
posted by ClaudiaCenter at 9:50 AM on September 26

She struggled through fall semester with the minimum full-time load at a four year college. With several incompletes, she finally ended up with a D average. At the recommendation of the school she took off spring semester but took a full-time load in the summer. She did better (a C average). She has also had non-stop physical complaints (some physical, some psychosomatic). She decided to return home and go to community college. Three months of FT school in the summer plus four months in the fall should maintain her status as a FT student for the year. (per my reading of IRS regulations). However, school started on Monday and she is falling apart. At this point, I don't think she can handle a full-time load - I'm hoping for half-time.

I understand your reasons for wanting to keep her as a full-time student, but are you sure that school is the best idea for her right now, emotionally? Many students aren't ready to be in college without your daughter's history of problems. And, while she hasn't worked in a long time, there are jobs out there with major food/retail companies (I'm thinking Barnes & Noble, Starbucks, and restaurants owned by the Outback corporation) that give health insurance to employees who average twenty working hours a week.

I've also known people for whom this type of employment was much more manageable and healthy than being in school was. And I don't get the feeling, through anything you've written, that she wants to be in school. It might be something worth talking to her about.
posted by PhoBWanKenobi at 10:17 AM on September 26 [1 favorite has favorites]

Seconding PhoBWanKenobi. In my case, school turned out to be the cause of my depression.
posted by trevyn at 10:40 AM on September 26

Have you considered helping your daughter to apply for Social Security disability? It's a long and tedious process but can guarantee some degree of protection. And the SSA does allow people who are disabled to work (some), so a part-time job or part-time course load might not be out of the question.
posted by brina at 11:41 AM on September 26

Finding a part-time employer that offers health insurance meeting Anon's daughter's needs sounds like a long shot to me, especially in this economy -- I'm not guessing the mental health benefits at Barnes and Noble or Starbucks are going to be very impressive. It also seems unwise to make her health insurance dependent on her stable employment given that that doesn't sound like a sure thing.

Anon, where do you live? Different states regulate health insurance in vastly different ways. Capability of "self-sustaining employment" may be a legal status defined more by, say, the opinion of a social worker than by the insurance company. Find your state's Department of Insurance and investigate there. Most are likely to offer insurance consumers a lot of expert help negotiating problems such as the one you're facing (see California's insurance consumer resources, for example). Good luck.
posted by gum at 3:36 PM on September 26

Finding a part-time employer that offers health insurance meeting Anon's daughter's needs sounds like a long shot to me, especially in this economy -- I'm not guessing the mental health benefits at Barnes and Noble or Starbucks are going to be very impressive.

While you're right that these jobs are in high demand these days, it's precisely because their benefits packages are really decent. You (and OP) shouldn't assume that just because a corporation is retail or food related, that their benefits package wouldn't offer its employees decent benefits packages.
posted by PhoBWanKenobi at 4:51 PM on September 26

There is an unsavory method you could use involving a local community college.
posted by mephesta at 9:45 PM on September 26

You say the local school offers no student health insurance. Perhaps there's another community college in your area that might offer student insurance. I know that the university-offered student plan here (through Aetna, not a community college) covers students on leaves of absence, which sounds like it would be pretty useful for your daughter. Since it's group health insurance, there ought not to be exclusions for pre-existing conditions, and most student health plans have mental health coverage for obvious reasons. Plus you have the school's health services office as an additional point of leverage if you get into a fight with the insurance company later. Really sounds like it would be your best bet if such a thing is offered anywhere near you. Good luck to you aned your daughter!

PhoBWanKenobi: As I understand it, a lot of retail employers have fairly long waiting periods before part-time employees are eligible for benefits. It doesn't sound like it would do much good for her to have to work for 12+ months before she was covered.
posted by zachlipton at 10:33 PM on September 26

It really depends on the state--this blog posts links to an excellent pdf that will give you an overview of various options. On page 8 there is a map of states that have extended coverage. There is also a summary of other options for her. Your state might have a government website that will discuss the insurance laws in that state. She might not have to be a student to benefit from your coverage.

For example, in New York, she would be covered until age 29 as long as you were covered. We have excellent mental health parity laws, so her mental health would be covered. It varies by state. Under Obama's health care plan, she would be covered until 25.

Your situation is tragic and you don't deserve this. Neither does your daughter. I apologize on behalf of my government.
posted by kathrineg at 11:45 PM on September 26

The OP is in California.

posted by kathrineg at 10:00 AM on September 27

PhoBWanKenobi: As I understand it, a lot of retail employers have fairly long waiting periods before part-time employees are eligible for benefits. It doesn't sound like it would do much good for her to have to work for 12+ months before she was covered.

Usually, the waiting period is 90 days; I know that's the case for both Starbucks (whose healthcare plan is Aetna) and Outback.

Again, I would try to talk to your daughter if she would have any interest in working instead of going to school. Even if you can get her a reduced course-load, starting part-time at a job in the meanwhile can position her to have another option in the spring semester if she really isn't doing well at school anymore. Again, I've known plenty of people (some of whom were clinically depressed, including my SO) who did swimmingly in work situations when school situations did nothing but make their depression worse. Exploring options for insurance that aren't dependent on student status will also help her school record, which is a good idea in the event that she's ever in a better emotional/psychological state to continue her studies.
posted by PhoBWanKenobi at 10:23 AM on September 27

Here is the most relevant text from an excellent website by Georgetown University Health Policy Website. There are other protections for disabled adult children there but this seems to fit the bill:

· If your son or daughter is in college and covered as a dependent under your group, but cannot maintain student status due to illness, he or she may still be able to remain covered as your dependent for up to one year. A new federal law allows dependent children who take a medically necessary leave of absence due to a serious illness or injury to remain covered as dependents under their parents’ group plan for up to one year or until the coverage would otherwise end, whichever comes first. This law will apply to plan years beginning on or after October 9, 2009. There is a similar California state law that currently applies to fully insured group plans.

Read your plan documents carefully to determine when your child will “age off” your group health plan.

For more information about this important protection, contact the U.S. Department of Labor at (866) 444-EBSA (3272).

posted by kathrineg at 10:25 AM on September 27 [2 favorites has favorites]

By the way, this

This law will apply to plan years beginning on or after October 9, 2009.

is the most relevant part of the bill. Ask your HR person when your plan year starts. Your daughter might be better off if she wrecks this semester but stays enrolled and becomes eligible for this continuation.

This is a long shot, but if there is any way you or your daughter could move to a state with guaranteed issue, market rate restrictions, and mental health parity, it would be ideal. What a weird thing to think about. Here is a site that lets you compare various states' laws regarding coverage.
posted by kathrineg at 10:49 AM on September 27

From the OP:

We are in California, thanks.
Also, I asked my daughter about work vs school. She thought a job would be less stressful than school in the short run but she would need more schooling to get a job she would like. Furthermore, unless her physical and mental health got much better, I'm pretty sure that her attendance record would get her fired from any full time job. (When she had a semester off from college she still had many issues and didn't follow through on most of her plans for things she had wanted to do during her time off.)

posted by kathrineg at 11:29 AM on September 27

If she gets kicked off of the plan, she can get COBRA and after that, CalCobra . Cobra might be subsidized by the federal government.

If she's not eligible for Medicare (I doubt she is) and she is not able to get coverage under COBRA or CalCobra, or by purchasing an alternate plan, she can apply for MRMIP. If she decides to apply for that, she should do so 60 days before she becomes eligible because then she will be put on the waiting list. Yes, there is a waiting list.
posted by kathrineg at 11:41 AM on September 27