Health Insurance Frequently Asked Questions
What is the Bates College policy about health insurance coverage?
Bates College requires that all students have active, comprehensive health insurance coverage while enrolled, including coverage for both emergency and non-emergency care, to ensure that students have coverage for local care to meet their health care needs while at campus.
Why does Bates College require students to have comprehensive and non-emergency health insurance?
Students are required to have comprehensive health insurance coverage to both help minimize catastrophic financial risk for students in the event of a health issue and to increase students’ access to health care during their time at Bates.
The College partners with Central Maine Medical Center to provide health care on campus at Bates Health Services, and bills insurance for services utilized, rather than charge a campus health fee. Therefore, to utilize services on campus you must have and provide proof of health insurance that covers primary care while you’re on campus.
Will my insurance cover the services provided at Bates Health Services?
If you have insurance through your family policy, you must let the company know you are at Bates College and determine how to handle all insurance claims while at Bates. Health Services bills your health insurance like your primary care provider. If your health insurance plan will not cover the services provided at Bates Health Services, like out-of-region HMO plans, then students will have the opportunity to enroll in the Bates Student Health Insurance Plan, in order to provide coverage to medical care while at Bates.
Health Services, like most healthcare clinics will be unable to process your claim, handle your bills, or answer any questions about your individual policy – you must work with your health insurance company directly.
In some instances, your insurance policy may require a referral to see a specialist; in this case our staff will contact your Primary Care Provider to expedite the referral. Pre-approval is often needed for x-rays, lab tests, and hospitalizations. If you have purchased the Bates College policy, the Patient Services Representative and the specialist at Cross Insurance Agency can help you with certain questions you may have. You are still responsible for understanding your policy and following the needed procedures and claim form requirements.
The Bates Student Health Insurance Plan Enroll – Waive Process
Annually, all students must enroll or waive health insurance coverage under the Bates Student Health Insurance Plan. The Bates Student Health Insurance Plan is compliant with the Affordable Care Act (the ACA). In order to waive the Bates SHIP, students must have comprehensive health insurance coverage that is considered to be “comparable coverage.”
The Enroll – Waive process for students returning for the fall semester opens in June and closes on August 27, 2021. The Health Insurance Enroll – Waive process is accessed through Garnet Gateway and administered by the Wellfleet Insurance Group. To complete this process, click on the Student Health Insurance Plan (SHIP) under the To-Do List on Garnet Gateway. This process is completed annually during the summer.
Students will be directed to and must input insurance information into the website of the Wellfleet Insurance Group, which administers the Bates College SHIP, which will determine if the student’s plan is sufficient to waive enrollment in the SHIP.
Students who do not complete the Enroll-Waive process by the appropriate date listed above will be automatically enrolled in the SHIP and charged the premium.
International students cannot decline coverage unless they are insured under a U.S. plan.
Questions about the Enroll-Waive process can be directed to Douglas Ginevan at firstname.lastname@example.org
What is the cost of the SHIP?
The 2021-2022 cost of coverage through the SHIP for the full 12 months is $1,996. For students returning to campus for the first time for the Winter semester and enrolling in the SHIP in January, the premium is $1,236.
Students who elect the Bates SHIP or are required to enroll in the plan will be billed the cost of the SHIP in September (students returning for the fall semester) or January (students returning for the winter semester.) Students receiving need-based financial aid from Bates may qualify for a full or partial grant subsidy, depending on their Bates-calculated family contribution, to help offset this cost.
What qualifies as “comparable health care coverage”?
Comparable coverage is a medical plan from a company based in the United States that provides health insurance benefits without lifetime maximums or pre-existing condition limitations. International students cannot decline coverage unless they are insured under a U.S. plan.
Generally, comparable coverage complies with the Affordable Care Act and provides equivalent or increased benefits than those provided under the Bates SHIP.
Comparable coverage must include coverage for:
- in-network health care providers who are located in Maine;
- ambulatory care (visits to doctors and other healthcare professionals, outpatient hospital care you get without being admitted);
- emergency care;
- hospitalization (such as surgery and overnight stays);
- pregnancy, maternity, and newborn care (both before and after birth);
- mental health and substance use disorder services, including behavioral health treatment (including counseling and psychotherapy);
- prescription drugs (including brand-name drugs and specialty drugs);
- rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills);
- laboratory services; and
- preventive and wellness services and chronic disease management.
Additionally, the annual out-of-pocket limit cannot be more than $8,550 for an individual or $17,100 for a family.
What does not count as “comparable health care coverage”?
There are many types of plans and coverages that are not considered comparable coverage. While many of these plans provide emergency coverage worldwide, they do not cover non-emergency care while you are outside of their service area. Below are examples of plan that are not considered comparable coverage:
- out of state Medicaid plans;
- regional HMO plans;
- travel insurance plans;
- health plans that only cover specific occurrences, such as accidents or certain illnesses;
- health plans that only provide emergency services;
- international plans (includes travel coverage from your home country);
- health care sharing plans;
- plans from insurance companies not located within the United States; and
- prescription discount plans (this is not insurance).