Individuals & Families

Some Schools are considering whether SHIP enrollment can be extended beyond the term of its expiration for Students who have just graduated. Are these extensions of SHIP coverage permissible?

The Health Connector’s regulations at 956 CMR 8.00 only describe the obligation for Schools to offer a SHIP, and for Students to either enroll in the SHIP or waive the SHIP by demonstrating they have comparable coverage. To the degree Schools have questions about who may validly be considered eligible to enroll in the SHIP, the Health Connector encourages Schools to work with their health insurance carriers, Third-Party Administrators, and the Division of Insurance (as applicable) to ensure that enrollment flexibility and extension of coverage modifications are permitted and, if so, are clearly explained in SHIP evidences of coverage, are available according to clear and consistently applied standards across all eligible newly graduated students, and remain consistent with applicable state law and federal requirements, including 45 CFR § 147.145.   Note: Student Health Insurance Program (SHIP) and COVID-19 Under 956 CMR 8.00, institutions of higher education, referred to as Schools in this Frequently Asked Question (FAQ), in Massachusetts are required to offer a Student Health Insurance Program (SHIP) to Students, and Students must either enroll in the SHIP or provide proof of comparable coverage. Due to the COVID-19 pandemic, some Schools are considering expanding remote coursework beginning in Academic Year (AY) 2020-2021, as well as arrangements to support graduating Students. This FAQ aims to help stakeholders understand options for Schools that are consistent with SHIP regulatory requirements as stakeholders consider the impact of a transition to remote learning or post-graduation arrangements on SHIP offerings and enrollment.

Some Schools have already opened their SHIP waiver processes for the upcoming academic year. If a School decides to move to remote-only learning, or if a Student decides to access courses remotely, after Students have already enrolled in the SHIP, should Students be allowed a SHIP premium refund?

The Health Connector strongly encourages Schools to work with their health insurance carriers and Third-Party Administrators to ensure they can timely disenroll individuals from the SHIP if Students have comparable coverage as defined in Question 3. To avoid undue operational complexity associated with disenrollment requests after SHIP coverage has begun for the academic year, the Health Connector urges Schools to offer an additional opportunity for Students to waive their SHIP.   Note: Student Health Insurance Program (SHIP) and COVID-19 Under 956 CMR 8.00, institutions of higher education, referred to as Schools in this Frequently Asked Question (FAQ), in Massachusetts are required to offer a Student Health Insurance Program (SHIP) to Students, and Students must either enroll in the SHIP or provide proof of comparable coverage. Due to the COVID-19 pandemic, some Schools are considering expanding remote coursework beginning in Academic Year (AY) 2020-2021, as well as arrangements to support graduating Students. This FAQ aims to help stakeholders understand options for Schools that are consistent with SHIP regulatory requirements as stakeholders consider the impact of a transition to remote learning or post-graduation arrangements on SHIP offerings and enrollment.

If a School receives a waiver from a Student who is participating in AY 2020-2021 classes remotely due to COVID-19, how should that School assess whether that Student has provided evidence of comparable coverage?

The Health Connector strongly encourages Schools to provide flexibility for Students who are learning remotely due to COVID-19 by permitting waivers where Students have comparable coverage in the location where they are currently participating in remote classes, including other states or countries. The regulations provide that a Health Benefit Plan submitted by a Student to waive the SHIP constitutes “comparable coverage” so long as it provides for: (1) “reasonably comprehensive coverage of health services, including preventive and primary care, Emergency Services, surgical services, hospitalization benefits, ambulatory patient services, mental health services, and prescription drugs”; and (2) access to those covered services is “reasonably accessible to the Student in the area where the Student attends School.” See 956 CMR 8.05(2)(a). The Health Connector notes that for the purposes of a Student participating in classes remotely for any term of AY 2020-2021 due to COVID-19, the “area where the Student attends School” is the location where the Student is currently remotely attending classes for the relevant term. See 956 CMR 8.05 (2)(c)(3). In addition, the Health Connector reminds Schools that they may waive participation in SHIP if the Student is studying in a foreign country and the Student has coverage in that foreign location. See 956 CMR 8.05 (2)(c)(2). In light of this interpretation, the Health Connector strongly encourages Schools to review their waiver processes to ensure that Students may waive SHIP coverage if they have comparable coverage such as out-of-state Medicaid, out-of-state Exchange Marketplace coverage (i.e., Qualified Health Plans), out-of-state employer [...]

The SHIP regulations at 956 CMR 8.02 define “Student” as “A Full-time or Part-time Student enrolled in a degree-granting program at a School who is not enrolled exclusively in online courses and whose enrollment does not consist entirely of Short-term Courses.” If Students participate in AY 2020-2021 classes remotely due to COVID-19, will they be considered “Students” under the Massachusetts SHIP regulations?

Yes; so long as those individuals otherwise meet the definition of a Full-time or Part-time Student under 956 CMR 8.01, they will be considered a “Student” under the regulations and would need to either enroll or waive out of the SHIP by demonstrating comparable coverage. Individuals who are in programs that are, by design, entirely remote and for whom COVID-19 is not the cause for their taking exclusively online courses, will continue to not be “Students” under the regulations, and therefore do not need to demonstrate enrollment in comparable coverage in order to waive the SHIP. The Health Connector encourages Schools to extend additional flexibility to Students who are attending class remotely due to COVID-19, as further detailed in Question 3.   Note: Student Health Insurance Program (SHIP) and COVID-19 Under 956 CMR 8.00, institutions of higher education, referred to as Schools in this Frequently Asked Question (FAQ), in Massachusetts are required to offer a Student Health Insurance Program (SHIP) to Students, and Students must either enroll in the SHIP or provide proof of comparable coverage. Due to the COVID-19 pandemic, some Schools are considering expanding remote coursework beginning in Academic Year (AY) 2020-2021, as well as arrangements to support graduating Students. This FAQ aims to help stakeholders understand options for Schools that are consistent with SHIP regulatory requirements as stakeholders consider the impact of a transition to remote learning or post-graduation arrangements on SHIP offerings and enrollment.

Will a School continue to be required to offer a SHIP for AY 2020-2021 if it moves to fully remote learning?

Yes; the transition to remote learning would not change a School’s requirement to make a SHIP available. See 956 CMR 8.03.   Note: Student Health Insurance Program (SHIP) and COVID-19 Under 956 CMR 8.00, institutions of higher education, referred to as Schools in this Frequently Asked Question (FAQ), in Massachusetts are required to offer a Student Health Insurance Program (SHIP) to Students, and Students must either enroll in the SHIP or provide proof of comparable coverage. Due to the COVID-19 pandemic, some Schools are considering expanding remote coursework beginning in Academic Year (AY) 2020-2021, as well as arrangements to support graduating Students. This FAQ aims to help stakeholders understand options for Schools that are consistent with SHIP regulatory requirements as stakeholders consider the impact of a transition to remote learning or post-graduation arrangements on SHIP offerings and enrollment.

How to update your account to apply for subsidies

If you are a Health Connector member and did not apply for subsidies, you can update your account to see if you may qualify for a free or low-cost ConnectorCare plan, MassHealth, or a tax credit that can be used to lower your monthly premiums right away. How to update your information, step-by-step: Step 1: Sign into your account and go to your "My Eligibility" page. You will see "Year 2020" application listed. Step 2: On the "My Eligibility" page, click "Edit Application" under the Actions column. If you don't see this link, skip to Step 3. Step 3: On the next page, you will need to click the "Report a Change" link under the Actions column. Step 4: On the next page, choose "Change application type". Then, click the "Report Changes" button to make your updates.   Step 4: You will be taken to the start of your application. Review your profile information and click continue until you get to the question "Do you need help paying for coverage?" Change your answer to "Yes, I want to see if I can get MassHealth or help paying for health care." When you click "Continue", you will need to go through the full application, updating your information as needed and answering questions about your household income.   When you sign submit your updated application, this updates your eligibility information. Please be sure to follow instructions on your Eligibility Results page as you may need to shop for a new plan or make a payment of a new [...]

Upload Documents (Proof)

You now have a new way to send your verification documents (proof) When you apply for coverage, renew, or update your information, you may be asked to send proof of some information that could not be electronically verified. Your proof can be sent to the Health Connector and MassHealth by Mail, Fax, In-person, and NEW Uploaded online through your account. Important: If you are sending proof, DO NOT send the same  document in more than one way. For example, don't fax and upload the same document for proof. How to upload your documents If you need to send proof, here’s how you can upload your document(s): First, log in to your online account. (If you don't have an online account, call Customer Service to get started with setting one up.) Once you are signed into your account, go to the new My Documents section of your account. Click on the Upload Documents link in the main menu to start uploading your files. Important: Make sure you have your proof saved where you can easily find and upload your document. On the Upload Documents page, under File 1, click the Browse button to find the file you want to upload from from computer, tablet, or smartphone based on the type of information we’ve asked you for. Select that file and click Open to start the upload. Note: You can only upload certain file types: Bitmap Image File (.bmp) Graphical Interchange Format File (.gif) JPEG Image (.jpeg) JPEG Image (.jpg) Portable Document [...]

What to Know If You Get Help Paying for Health Insurance from Both the Health Connector and Your Employer

Overview A Health Reimbursement Arrangement, or HRA, is an employee health benefit from your employer that reimburses you for your health care expenses up to a certain dollar amount. There are several types of HRAs. This page focuses on two types: Individual Coverage HRAs and Qualified Small Employer HRAs (QSEHRAs). If you are offered one of these types of HRAs, you should have received a clear notice from your employer explaining the terms of the Individual Coverage HRA or the QSEHRA. The type of HRA will appear prominently on that notice. If your employer offers an Individual Coverage HRAor a QSEHRA instead of a traditional employer health insurance plan, you can use it to help pay your monthly premiums for a health plan purchased through the Health Connector. However, if you are offered an Individual Coverage HRA or a QSEHRA and are also eligible for subsidies through the Health Connector, you might be at risk of owing money to the IRS at the end of the year when you file taxes. To learn how these types of HRAs might affect your tax credit eligibility and what to do next, visit the Health Connector’s HRA tool. Have your HRA notice on hand, as you will need information from it to use the tool. You can also read more below about Individual Coverage HRAs and QSEHRAs and the steps you can take to protect yourself from owing money back to the IRS at tax time. Find out [...]

Can I get help paying for health insurance through the Health Connector?

If you are applying for health coverage and are not sure if you qualify for help paying for your insurance, we offer a tool to help you estimate if you may be eligible. To use this tool: Go to the login landing page here. On that page, you will see a section that reads "See What You May Qualify For" Enter your zip code, select a coverage start date and choose "Yes" to the question "Do you want to check to see if you are eligible for help paying for costs?" Click "Start Now" to use the tool, answering all the questions on the following pages. Remember: The results from the tool is only an estimate of what you may qualify for. You will need to complete an application to get your actual eligibility decision. You may qualify if you: Shop through the Massachusetts Health Connector Live in Massachusetts Are a U.S. citizen, national, or are otherwise lawfully present in the U.S. Have income that is 400% of of the Federal Poverty Level (FPL) or or lower (see chart below) You won’t be able to qualify if you: Get coverage through Medicare, MassHealth (Medicaid), or other public health insurance programs Are in jail at this time Are offered affordable, comprehensive health insurance from an employer. Note: If the cost of your employer’s health insurance plan for individuals is more than 9.56% of your income, then that coverage is not considered affordable. Household [...]

Hardship exemption and how to apply

If you are over age 30 and have applied for and was approved for a federal hardship exemption, you may be able to shop for a Catastrophic plan. For information about the federal hardship exemption, including how to apply, go to the hardship exemption page on HealthCare.gov → Were you already approved for a federal hardship exemption? If you have a federal hardship exemption and want to shop for a Catastrophic health insurance plan through the Health Connector, please call Health Connector customer service at 1-877-MA-ENROLL (1-877-623-6765), or TTY 1-877-623-7773 for people who are deaf, hard of hearing, or speech disabled. Health plans that meet all of the requirements applicable to other Health Connector plans but that don't cover any benefits other than 3 primary care visits per year before the plan's deductible is met. The premium amount you pay each month for health care is generally lower than for other health plans, but the out-of-pocket costs for deductibles, co-payments, and co-insurance are generally higher. To qualify for a Catastrophic plan, you must be under 30 years old OR get a "hardship exemption" because the Marketplace determined that you’re unable to afford health coverage. Catastrophic health plans: For people under 30 or with certain exemptions Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself. Who can buy a [...]