It is back-to-school time, and that means millions of studentsheading off to college. But along with new clothes, backpacks, andlaptop computers, a growing number of collegians need another itembefore they can start class — health insurance.

Florida State University (FSU) is one of the nearly one-third ofU.S. colleges that mandates that all students have healthinsurance. The schools have added the requirement for severalreasons. Health insurance most assuredly means students have betteraccess to care if they are sick, and healthy students make betterstudents. However, the requirement also helps ensure that healthcenters at the universities are paid when they provide services tostudents.

Lesley Sacher, director of the Thagard Student Health Center atFSU, said most parents are supportive of the requirement, whichenters its third academic year this fall. “I have been amazed,”Sacher said, noting the idea did meet some resistance when it wasfirst launched.

An estimated five million college students are uninsured — outof 17.5 million, according to the U.S. General AccountabilityOffice (GAO). Put another way, college students make up about 12percent of the 46 million uninsured U.S. residents. Young adultsbetween the ages of 19 and 29 represent the largest segment ofuninsured, with nearly one in three lacking coverage. These are theso-called “young-invincibles,” who think illness and injury willnot affect them, so they can manage without insurance.

Small Price to Pay

For most Americans, the biggest barrier to health insurancecoverage is cost. They cannot afford the $7,000 average premium orhigher rate if they have a pre-existing condition. For many collegestudents, though, cost is actually a much smaller hurdle. FSU sellsthe policies through its carrier, which this year is Blue Cross andBlue Shield of Florida (BCBS Florida). A basic plan with limitedbenefits costs $929 for the full year. A more comprehensive optioncosts $1,250.

The relatively low costs are one effect of the school requiringall of its students to have coverage. More students in the planmeans more students to spread the insurance risk. While most FSUstudents get coverage through one of their parents, the number ofstudents getting a policy through the university-chosen carrier hasjumped to 4,200 this year from 900 just three years ago.

FSU makes the insurance enrollment process simple. Students, ormore likely their parents, can sign up for coverage online withoutever talking to an agent. It even has a tutorial on its web site towalk applicants through the process.

John Urbanek, a vice president at BCBS Florida, said theinsurance mandate at FSU is a success story for all involved —students, the school, and the insurer. “We hope this will be amodel that others will follow,” said Urbanek, who has a daughter atthe university.

Having the school mandate insurance coverage “really gives us alarge group to work with so we can keep our costs low and the riskpool becomes more predictable,” Urbanek said.

Until recent years, major carriers largely ignored the collegecampus market, leaving it to smaller specialty carriers. But thegrowing number of individual schools nationwide to mandate coveragein addition to some states and university systems has made themarket more enticing. “We thought this would be a market that wecould be competitive in,” Urbanek said.

BCBS Florida outbid rival Aetna this year to be FSU's maininsurance carrier for students.

Aetna made a big move into the student health insurance marketwhen it bought the specialty carrier, The Chickering Group, in2004.

“We support the efforts of colleges and universities to ensurestudents have access to affordable, quality health care,” said KateBegley, head of Aetna Student Health. “At Aetna, we work closelywith campus health and counseling centers, as well as community andtravel service providers, to offer students access to convenientcare at an affordable price, no matter where they are located.”

Whether a student is attending college for the first time orreturning to campus for another year, Aetna offers these tips forparents to consider when selecting a student health insuranceplan:

o Weigh the difference of carrying a dependent on your plan withthe benefits of a school plan. For example, will your plan cover anon-emergency?

o Evaluate the access to care for a typical student who istraveling to school, home, participating in travel abroad programs,medical rotations, or internships. A portable plan with nationaland international coverage is essential.

o Identify a health contact on campus and review the school'sweb site and literature. Visit the campus health center.

o Understand the school's health insurance requirements and planprovisions, including specific annuals and other benefit limits andexclusions. Talk with the school health insurance staff forguidance.

Coverage Options

“Choosing a student health insurance plan that is right for yourchild is a personal decision and one that should be examinedcarefully, particularly in today's uncertain economy,” Begleysaid.

Provisions of college student health insurance vary widely. Somelimit the number of doctor visits, prescription drug coverage, andlength of hospital stays. The maximum benefits on these plans canalso be extremely low, such as $2,500 per condition (per year) to$1 million per lifetime, according to the GAO.

Even if universities do not mandate that students carryinsurance, schools often contract with an insurer or local agencyto obtain a preferred rate. Insurance experts say it is wise forparents to consult with an agent before making any decisions.

“It is always a good idea to shop around and, depending on whatplan the college endorses, to find an agent to evaluate otherproducts,” said David Sherrill, executive director of the FloridaAssociation of Health Underwriters in Altamonte Springs.

Sherrill said the university-endorsed plan is often a good deal,particularly for international students, but that in-state studentsshould look at all their options.

Despite the growing trend, most Florida agents get few inquiriesabout coverage for college students. “It happens every once in awhile,” said Stephanie Joy, an agent with Plastridge Insurance inWest Palm Beach. Joy said parents should consider keeping or addingtheir college-bound children to their own policy or have a rideradded to their policy. They also should consider making sure thatwhatever plan is chosen has a provider network both at the collegeand in their hometown that can be used in case of a seriousillness.

The University of Florida (UF) has contracted with theGainesville-based Scarborough Co. for 12 years to develop healthplans for its students. This year, it offers a plan that costs aslittle as $1,391
a year.

“Demand is higher this year than previous years,” said RickScarborough, owner of the insurance agency. The agency helps writepolicies through Aetna for about 8,000 undergraduate and graduatestudents at UF. He attributes increased interest in student healthinsurance to the worsening economy, which has caused many parentsto lose their jobs, along with their family health insurancecoverage.

Nonetheless, he said student health insurance remains a toughsell. “Health insurance is pretty far down the list of students'priorities,” Scarborough said.

BCBS Florida estimates it has about 8,000 to 10,000 studentsenrolled at FSU and the six other Florida colleges where it hascontracts.

Unlike Florida, some states and higher education governingboards have implemented health insurance requirements for collegestudents. For example, Massachusetts and New Jersey requirestudents attending college in their states to have health insuranceas a condition of enrollment.

Florida lawmakers have considered such a proposal the past fewyears, but it has never been implemented for fear it would make theoverall cost of going to college too expensive.

Sacher of FSU is still hoping to get an alliance of universitiesin Florida to join together in requiring students to have coverage.“Together we would have stronger bargaining chip with insurers,”she said. But today, FSU is the only state school to requirestudent health coverage.

Starting this October, a new federal consumer protection willhelp secure student coverage. Under Michelle's Law, all groupinsurance plans must cover students on medical leave for up to oneyear. The law is named for Michelle Morse, a student in NewHampshire who died of colon cancer in 2005. She had continued herfull college course load throughout her treatment so she could keepher health insurance.