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.

You can contact me directly at [e-mail]

posted by anonymous to Health & Fitness (10 answers total)

Hi, anon. I sent an e-mail your way.
posted by Zosia Blue at 9:12 AM on September 26, 2009

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, 2009

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, 2009 [1 favorite]

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, 2009

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, 2009

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, 2009

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, 2009

There is an unsavory method you could use involving a local community college.
posted by mephesta at 9:45 PM on September 26, 2009

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, 2009

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, 2009