填空题

案例分析题Filling in the Insurance Gap for Adult Children
A．Tamar Zaidenweber, a 24-year-old graduate student at Georgetown University, lost her insurance coverage (保险范围) under her father’s health plan in 2008 because she was no longer financially dependent on him. Because of the new health care law, she will be able to rejoin his policy. But not until January. In the meantime, she will renew the student policy she had last year, even though the coverage isn’t as good and the price, $1745 for the year, is much steeper than rejoining her father’s plan, which she will be able to do free. "It’s extremely frustrating," she said.
B．Finding a health plan for college-age children isn’t something parents have had to think much about. Most decide to keep their children on their employer’s plan, which is typically more comprehensive than coverage offered through the school or in the market for individual policies. But many health plans limit coverage of college-age children for a variety of reasons, including age, whether they live at home and whether they are financially dependent. For families with those plans, the choices are more difficult. And the health care law has added wrinkles to an already complicated decision.
C．Under the new law, employers will be required to offer to cover adult offspring until they are 26, regardless of their student status or whether they are financially dependent on their parents. The provision takes effect on or after Sept. 23, 2010, whenever health plans renew coverage. For many companies, that means January 2011, but for others it could be March or even July. So students like Ms. Zaidenweber face a gap in coverage of several months. Because of a pre-existing condition, she does not qualify for an individual insurance policy to tide her over until January, when she will rejoin her father’s plan. But Georgetown won’t permit her to buy student coverage for just one semester, so beginning in January she will be doubly insured. For many such students and their families, finding adequate health insurance remains a challenge. Here are strategies to consider.
Employer Plans
D．Employer plans generally offer more comprehensive coverage than student or individual policies. But don’t assume the company plan is the best choice. If you haven’t done so, check with your human resources department to make sure your child will be covered in the fall. If there is going to be a gap, find out your health plan renewal date and when the enrollment period (申报登记日期) will be held to add adult children. If your plan doesn’t renew until next year, under the federal Consolidated Omnibus Budget Reconciliation Act, you can keep your child on your employer plan in the interim, (中间时期). But you will be responsible for paying the premium to cover the child.
E．Cost is another important question. Once the plan renews its policy, the new health care law prohibits employers from charging a higher rate for adult children who are newly qualified for coverage. Companies can charge more for all dependents, however, and many may do so.
F．In a recent survey by Mercer, a human resources consulting firm, one third of employers said they would strongly consider increasing the premiums for dependent coverage to offset the higher costs of covering adult offspring. If your company plans to do this, you may want to consider other options, such as individual insurance, especially if your child is healthy.
G．The new health care law eliminates some barriers for parents who want to keep college students on the family plan, but obstacles remain. One all-too-common difficulty. If your child is going to school out of state, your health plan may not cover most services there. That’s the situation facing the Davis family of Malibu, Calif. Skyler Davis, 18, is heading to Drexel University this fall, but the family’s health maintenance organization will cover him only for emergency or urgent care, not routine doctor appointments, while he’s in Philadelphia. So the Davises will probably buy Drexel’s student plan, at $1140 a year. Elyse Davis concedes she does not like the $50000 per condition per lifetime cap on benefits. "You go into the hospital for two days, and that could do it," she said.
Student Policies
H．A majority of colleges offer student health insurance, and some provide solid coverage—but they are the exception. "Most student plans are really bad," said Stephen Beckley, a health care management consultant for colleges and universities in Fort Collins, Colo. Student health plans must meet new standards under the health law, but the specific regulations have not been issued. The law is likely to have no effect this fall, since those health plans are already in place.
I．If you’re considering buying a college plan, look for several important elements, said Mr. Beckley and other experts. They include: catastrophic coverage of at least $1 million in lifetime benefits; no exclusions of coverage for pre-existing conditions if your child was covered immediately before signing up; first-dollar mental health coverage, not subject to a deductible (免赔额); and solid prescription drug coverage.
J．As more parents see cuts to their generous employer health benefits or lose them entirely, some student health plans, even ones that aren’t particularly robust, are starting to look at least somewhat attractive. Donna and Brent Funck’s daughter Brenna, 18, will attend Tulane University in New Orleans this fall. Mr. Funck owns a software business, and the family is insured through an individual policy. Brenna Funck, however, has a congenital (先天的) heart defect that makes her difficult to insure. The Funcks pay $300 a month for a separate individual policy for her, with a $2500 deductible.
K．Tulane’s policy isn’t ideal for someone with a medical condition that may require expensive care. The policy maxes out at $250 000 per condition per lifetime. "One event that requires surgery would wipe that out," Ms. Funck said. But the $1754 annual premium is a lot less than the Funcks pay, and the deductible is just $250. Despite reservations, they said they would sign her up.
Individual Plans
L．If the parents’ insurance isn’t an option and the school policy is poor or nonexistent, students who are healthy may be able to get a good deal on an individual policy. The average rate for an 18- to 24-year-old is $106 a month for a plan with a $2300 deductible, said Carrie Mclean, a consumer specialist with eHealthInsurance, com, which sells policies from 180 insurers through its Web site. Individual policies are not known for being generous, but they may be a better choice for students than in years past. Under the health care law, new individual plans must meet new standards beginning Sept. 23, including no lifetime limits on coverage and free preventive care.
Skyler Davis can’t be covered by most services in his parents’ health plan after he goes to Drexel University.