Health insurance is confusing. Chimes sat down with Dr. Laura Champion, director of Calvin’s Health Services, to answer common questions students have about health insurance. The conversation has been edited for length and clarity.

Chimes: How does health insurance work?

Dr. Champion: Health insurance is a plan that people buy in order to get returns on all types of medical care. Most plans cover doctor’s visits, emergency room visits, hospital stays, and medications.

The idea behind health insurance is simple: Most people can’t pay for health care out-of-pocket. But if a group of people gets together, and each person pays a fixed amount, the risk is spread out over the whole group.

Chimes: What insurance options are available to students?

Dr. Champion: Most domestic students are on their parents’ health plan, which is permitted until age 26. Calvin also provides a student health insurance plan. Most international students use this plan, as well as some domestic students. Calvin works with a third party broker to negotiate a contract with an insurance company for the student health plan.

Chimes: What is the difference between using Calvin’s student insurance plan and using a family member’s health insurance plan, or another insurance option?

Dr. Champion: Without pooled plans — such as health insurance provided by an employer, or Calvin’s student plan — an individual plan usually costs $400-$1000 per month.

Most pooled plans that students are a part of from their families come from their parents’ employer. These plans usually have a deductible, which is the money you must pay out-of-pocket before your insurance plan will start to cover any costs. About 20 percent of those plans have a deductible that is $1,000 or higher. About 80 percent of students on their parents’ plan do not have a deductible to receive care for doctor’s appointments or vaccines. About 75 percent of students on their parents’ plan have a copayment. This is a fixed amount that an individual must pay beyond the copayment.

The most common copayment for care for students under their parent’s plan is $50/visit at Health Services. About 25 percent of insurance plans used by students who are on their parents’ plan have no co-payment. So the cost of that care is completely covered by their family insurance plan when they come in for vaccines or a doctor’s appointment if our practice is listed in-network.

There are over 500 students on Calvin’s student health insurance plan. The deductible is $250. When someone signs up for the student health plan at Calvin, the care received in our Health Services is 100 percent covered. This includes doctor’s visits, psychiatry care visits, dietician visits, lab draws and a limited supply of prescription medication kept in our office. 

Chimes: How does payment for services outside of Health Services work for students on Calvin’s health insurance plan?

Dr. Champion: When a student leaves our office for care, there are copayments and a one-time annual deductible ($250). The student health plan co-payment for an outside doctor’s appointment is $50 + 20 percent coinsurance. This means that after the on-time deductible is met, if a doctor’s visit is $200, the student would be responsible for $50 + $30 (20 percent of the remaining $150) for that appointment. If the outside provider is out-of-network, and the deductible was met, then the same visit would have a higher cost.

Chimes: What is the difference between being in-network and out-of-network?

Dr. Champion: When a provider is in-network with a particular insurance company, that doctor’s office negotiates a lower rate of payment with that carrier and agrees to take a lower payment for that level of care. This reduces health care costs and helps keep premiums down. The benefit is that that office is listed as an in-network (preferred) provider in that area.

When a provider is listed as “out-of-network”, then the charges for that service are paid by insurance at the fair market value. and some out-of-network providers charge higher than FMV. Insurance companies want their clients to go to the in-network, preferred provider. The deterrent is set up such that the patient is responsible for the copayment and 40 percent of the remaining cost of the visit. Any costs above the fair market value become the responsibility of the individual.

Chimes: How can students make sure that Health Services is in-network for their insurance plan?

Dr. Champion: Students who live out of state often have a national insurance plan that will allow them to change their home provider to my name. This allows their plan to see our office as in-network. Some plans do not permit this change. Kaiser Permanent is one of those plans. These students can come to Health Services and their insurance is charged, but the student is responsible for any portion of the plan that is not covered by their insurance. 

Chimes: How can students determine if the service that they need will be covered by their insurance?

Dr. Champion: To find out if a service rendered in Health Services is covered by your family insurance plan, such as doctor’s visits, vaccines and other medical care, go to your own plan’s benefits website to learn more. Each plan is different.

For medical care, out-of-state plans will often cover medical services when an in-network provider is out of state for reasonable care needs. Most visits are considered reasonable.

Most vaccines are covered 100 percent when given at a primary care office. Some insurances limit where vaccines can be given so if our office is not listed as your primary care office, check with your insurance before receiving your vaccine.

Because only the student health plan covers the cost of in-house prescriptions, Health Services works with a local pharmacy to deliver scripts to our office each day. These scripts are paid for by the student’s insurance plan (with usual co-payments). We are a dispensary, not a pharmacy, which means we cannot fill a script from an outside provider unless we prescribe that drug during an office visit at our clinic. 

For blood draws, our office acts as a lab drawing place on campus for students who received a lab order for an outside provider. Bring the lab order in and set up a nurse visit and we can draw that lab and send the results to the ordering provider.

Chimes: How can students change their primary care provider?

Dr. Champion: Insurance carriers allow a patient to change their listed primary care provider two times per year. This allows a student to list Health Services as their primary care provider when in Grand Rapids and then change the provider to their home-town provider when home for the summer. It is your responsibility to know what your plan covers and what is your responsibility, so check with your insurance plan or make sure our office is listed as your primary care provider office while attending Calvin.