Many MIT students choose full protection through the MIT Student Extended Insurance Plan, which is specifically designed to coordinate with the free care we provide on campus through the MIT Student Medical Plan.

But, deciding on a health plan can be a difficult process. To help you choose the right coverage, here are the most frequently asked questions we receive from students.

1. What requirements do I need to meet to waive the MIT Student Extended Insurance Plan?
• General requirements
• Inpatient hospitalization requirements
• Outpatient services requirements
• For J-1 visa holders only
2. If I waive the Extended Insurance Plan, do I waive all medical coverage on campus?
3. I already have health insurance through my parent's plan, and it meets all the requirements for waiving the MIT Student Extended Insurance Plan. Why should I consider the Extended Insurance Plan?
4. Can I waive with international insurance?
5. How will my home HMO coverage work for me when I'm on campus?
6. If I am injured playing sports, will my insurance cover prompt treatment?
7. What about other services beyond treatment for injuries and medical tests?
8. I have an MIT certificate, can I complete the waiver form online for my son or daughter?
9. Do I have to waive every year?
10. I'm covered under another plan, but my spouse and children don't have health coverage. Can I get them covered through MIT?
11. I waived but now have changed my mind. When can I enroll in the MIT Student Extended Insurance Plan?
12. I'd still like to waive the MIT Student Extended Insurance Plan. What should I do?

1. What requirements do I need to meet to waive the MIT Student Extended Insurance Plan?

• Massachusetts law sets minimum standards for student health insurance programs, which are summarized below. Click here to view the complete standards.
• Students with J-1 visas under MIT visa sponsorship must also meet United States regulations
• Your insurance MUST meet all these requirements in order to waive the Extended MIT Hospital Insurance Plan
• If you waive the MIT Student Extended Insurance Plan and you are referred to a health care provider outside MIT Medical, you are responsible for the expenses. MIT and the MIT Student Extended Insurance Plan will not pay for this care.

Requirements Summary

General Requirements
Massachusetts has set minimum standards for qualified student health insurance programs. Any student enrolled at MIT has the option of waiving the MIT Student Extended Insurance Plan only if the student is enrolled throughout the school year or current academic term in a health insurance program that the student determines provides coverage comparable to a Massachusetts qualified student health insurance program. You must determine that your own health insurance includes all benefits mandated by Massachusetts law. Because of the extremely high cost of medical care in Boston, we also recommend that your coverage be comparable to the MIT Student Extended Insurance Plan. In addition, make sure that you can actually use your own insurance while you are in Boston.
Your coverage must include all benefits mandated by Massachusetts insurance law, including (but not limited to):

• mental and nervous conditions (including biologically based conditions and rape victim disorders) for up to 60 inpatient days per year
• alcohol and drug abuse treatment
• maternity care
• Christian Science practitioners, with the same exclusions, limitations and benefit levels as other services
• an ambulance in an emergency, subject to a $25 deductible, up to a maximum of $125 per illness or injury

If there are overall maximum limits, coverage for all benefits for each illness/accident must be at least $25,000.

Inpatient hospitalization requirements
Hospital charges for room and board and special services in a semiprivate or intensive care unit must be 80% of covered charges for each illness or accident.

Physician fees (excluding surgery) must be covered at 80% of covered charges for each illness or accident.

Surgical services must be covered at 80% of covered charges for expenses actually incurred for surgery, up to a maximum of at least $5,000 for each surgical procedure; plus coverage for anesthetist or assistant surgeon services up to 30% of the amount reimbursed under the surgical coverage.

Outpatient services requirements
Basic benefits for expenses actually incurred in a physician's office, hospital outpatient department or emergency room, clinical lab, radiological facility or other similar facility licensed by the state, must be covered at 80% of covered charges, up to a maximum of at least $1,500 for each illness or accident. A deductible or copayment may be charged for each visit but cannot be larger than:

• $100 for each hospital or emergency room visit that does not result in an admission
• $50 per visit to a hospital outpatient department
• $25 per visit to a physician's office

Surgical services are covered at the same rate as listed above for inpatient surgery.

High cost procedures (over $200) must be covered at 80% of covered charges up to a maximum of at least $2,000 per illness or injury.

Outpatient mental health: must fully cover at least 24 outpatient visits per year. For biologically based conditions, rape victim disorders, and care for persons under age 19, coverage must be at least as extensive as coverage for outpatient medical conditions.

Outpatient contraceptive services, if offered, must be offered on the same terms and conditions as all other outpatient services. If prescription drug coverage is offered, it must cover FDA-approved contraceptive drugs on the same terms and conditions as all other drugs.

For J-1 visa holders only
Students with J-1 visas under MIT visa sponsorship must have insurance that also meets United States Department of State regulations for themselves and their spouses and children who accompany them

• Medical benefits of at least $50,000 per accident or illness
• In case of death, repatriation of remains in the amount of $7,500
• In case of serious illness or injury, payment of expenses associated with the medical evacuation of the student to their home country in the amount of $10,000
• A deductible not to exceed $500 per accident or illness

2. If I waive the Extended Insurance Plan, do I waive all medical coverage on campus?

No, even if you waive the Extended Insurance Plan, you still have access to the MIT Student Medical Plan which is FREE with tuition.

3. I already have health insurance through my parent's plan, and it meets all the requirements for waiving the MIT Student Extended Insurance Plan. Why should I consider the Extended Insurance Plan?

The MIT Student Extended Insurance Plan provides very comprehensive coverage. Before deciding, compare the benefits to those in your existing plan and find out how your current insurance works away from home.

For example, MIT Student Extended Insurance Plan members who need hospital care while they're in Cambridge can be cared for in the nearby, world-class medical facilities we typically use, such as Massachusetts General Hospital, and Mt. Auburn Hospital, and MIT Medical physicians will coordinate the care. Would your current insurer expect you to use its own affiliated hospitals - perhaps in a different state?

4. Can I waive with international insurance?

No. As of August 1, 2006, MIT Student Health Plans no longer accepts insurance plans with international carriers. The state of Massachusetts stipulates that students cannot waive with coverage from insurance carriers outside of the U.S., unless the student is studying in a foreign country and the student's insurance provides coverage in that location.

5. How will my home HMO coverage work for me when I'm on campus?

Your home HMO might not work well in the Boston area. You may even find that you have to leave campus and return home to get the care you need, because many HMOs have restrictions on out-of-area coverage. This may be a problem for you if a clinician at MIT Medical refers you for care off-campus, or if you decide to seek care off-campus yourself.

For you to be eligible for payment, HMOs typically insist that all care be authorized in advance and coordinated by your primary care physician. Further, HMOs generally prefer or require members to use services in their network.

Read your policy carefully, and ask your HMO primary care physician or Member Services Department about the requirements.

6. If I am injured playing sports, will my insurance cover prompt treatment?

Most sports injuries can be treated promptly on campus. The MIT Student Medical Plan (automatic enrollment for all students with tuition) covers medical services provided at MIT Medical. MIT Medical offers urgent care twenty-four hours a day, seven days a week. Lab tests and X-rays are available at MIT Medical during normal business hours.

Evaluation and treatment services provided outside MIT Medical, for sports injuries that occur while traveling, for example, or more extensive services such as hospitalization, surgery, or physical therapy are not covered by The MIT Student Medical Plan. In these situations, the coverage provided by either the MIT Student Extended Insurance Plan or your parent's insurance would apply.

The MIT Student Extended Insurance Plan covers a wide variety of treatments off-campus. Some of these covered off-campus services will require you to pay a deductible or coinsurance. The MIT Student Extended Insurance Plan coverage meets or exceeds all Massachusetts and Varsity/NCAA health insurance requirements. For more information about the MIT Student Extended Insurance Plan coverage see http://web.mit.edu/medical/p-studextended.html.

If you plan to use your parent's insurance plan, you should review your coverage carefully to see what is covered if you are injured while at MIT. Would you need to obtain prior authorization from your insurance plan before receiving care? How long would this process take? Does the coverage meet the requirements for Varsity/NCAA athletes? In addition to Massachusetts insurance requirements, Varsity/NCAA sports team participants need to ensure that they have coverage for sports injuries, that the coverage remains active during participation, and that the plan includes a provision for sports injury/illness related medical care with a limit of at least $75,000. For more information about the requirements related to Varsity/NCAA sports teams please go to: http://web.mit.edu/athletics/www/.

7. What about other services beyond treatment for injuries and medical tests?

With the MIT Student Health Plan, you have two excellent sets of coverage: the MIT Student Medical Plan and MIT Student Extended Insurance Plan.

First, we encourage you to use the services at MIT Medical. In the Mental Health Service, for example, we have recently hired additional clinicians and expanded our on-campus services for students. As a tuition-paying student, you are automatically enrolled in the MIT Student Medical Plan, which provides full coverage for these services and other office visits at MIT Medical.

If you enroll in the MIT Student Extended Insurance Plan, you have additional coverage for mental health services outside MIT Medical. (Please note that office visits outside MIT Medical, other than for mental health, are generally not covered.)

8. I have an MIT certificate, can I complete the waiver form online for my son or daughter?

No. Students must complete the online waiver form using their own certificate.

9. Do I have to waive every year?

You must file a new waiver form each academic year. In the fall, you can waive for fall only or for both fall and spring semesters. If you don't file a form, you will automatically be enrolled in the MIT Student Extended Insurance Plan.

10. I'm covered under another plan, but my spouse and children don't have health coverage. Can I get them covered through MIT?

You may purchase coverage for your spouse and children if you belong to the same plan yourself. If you want them covered under the MIT Student Extended Insurance Plan, you must also purchase MIT Student Extended Insurance Plan coverage for yourself.

11. I waived but now have changed my mind. When can I enroll in the MIT Student Extended Insurance Plan?

Please contact the MIT Health Plan office at 617-253-4371 or stop by E23-308. Be sure to have information about your current health plan available when you talk with the MIT Health Plan office.

12. I'd still like to waive the MIT Student Extended Insurance Plan. What should I do?

Waiver requests for the fall term or academic year will be accepted beginning in July and must be submitted by September 30. Waiver requests for spring term only will be accepted beginning in December and must be submitted no later than February 28. Waiver requests for summer term will be accepted beginning in April and must be submitted no later than June 30. Please note that the Summer term waiving period is only for students registered for the Summer term.

If you decide to waive the MIT Student Extended Insurance Plan, please follow the instructions for our online waiver process (MIT Certificate required). If you are unable to use the online form, contact us at stuplan@med.mit.edu.