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The Marketplace vs.
Aetna Student Health

What is the Marketplace and what impact does it have on me?

The Marketplace is a website where individuals may go to purchase health insurance. The Affordable Care Act (ACA) requires individuals to have health insurance that meet the Minimum Essential Coverage. Your Rice University Student Health Insurance Plan, administered by Aetna Student Health, meets this requirement.

Does the Student Health Insurance Plan qualify as health insurance under the new ACA federal law?

Yes, the Rice University Student Health Insurance Plan meets the ACA requirements and provides all mandated benefits.

Can I buy the Rice University Student Health Insurance Plan on the Marketplace and get a premium tax credit or cost-sharing assistance?

No, you cannot buy the Rice Student Health Insurance Plan on the Marketplace, nor can you get a premium tax credit or cost-sharing assistance for the Rice Student Health Insurance Plan. Student plans under ACA are treated separately because the cost of coverage and benefits reflect the student population and should be more affordable than many of the individual plans on the Marketplace.

Aren’t some of the individual plans on the Marketplace supposed to be low or no cost if I qualify for a premium tax credit or cost-sharing support based on my income?

There may be low-or no-cost choices if you qualify for assistance based on earnings, but the Marketplace plans may not offer the same level of benefits you get on the Rice Student Health Insurance Plan. In other words, even though the monthly cost for an individual plan could be less, the amount you pay if you need services could be higher due to higher deductibles and higher coinsurance.

Are the enrollment periods the same for insurance with the Rice Student Health Insurance Plan as it is in the Marketplace?

Open enrollment periods on the Marketplace do not necessarily coincide with the academic semester meaning students may be uninsured at points during the year. The Rice Student Health Insurance Plan offers open enrollment for annual, and fall only coverage, starting with each academic year.

What is the benefit of the Rice Student Health Insurance Plan compared to the individual plans on the Marketplace?

The Rice Student Health Insurance Plan gives you access to basic health care services along with office visits, prescriptions and many preventive services at a low to no out-of-pocket cost. If you need to see a doctor off-campus, you have access to a comprehensive network of doctors, hospitals and specialists provided by Aetna network. The Aetna in-network provider list may be more extensive than the in-network list you would have on a Marketplace and the network is nationwide. The Rice Student Health Insurance Plan includes global emergency services, which are valuable to students traveling abroad. Also, once you enroll in the Aetna Student Health plan, you are automatically enrolled in the Vital Savings Discount program which provides discounts for numerous dental services and procedures. Many of the plans on the Marketplace do not provide cost assistance for dental services. Lastly, If you are eligible for the graduate subsidy, it is a requirement that you be enrolled in the Rice Student Health Insurance plan to qualify.

If I choose to purchase a plan on the Marketplace, what benefits must I have in order to qualify for the insurance waiver?

The plan must meet all of the waiver requirements set by Rice University.

  • The plan provides unlimited annual and lifetime benefits (i.e., no policy maximum).
  • The plan provides coverage for non-emergency inpatient and outpatient medical and mental health care in Houston, TX.(Coverage for emergency‐only care does not satisfy the requirement).
  • The plan's coverage is not through a medical cost sharing or co-op type of program.
  • The plan provides prescription coverage.
  • The plan’s deductible is no more than $5,000.
  • The plan is currently active and you agree to maintain health insurance throughout the policy year. If you lose coverage you will notify Rice immediately.

Compare Costs

The Marketplace allows individuals to purchase plans based on a metallic system:

  • Bronze: health plan pays 60% on average; you pay about 40%
  • Silver: health plan pays 70% on average; you pay about 30%
  • Gold: health plan pays 80% on average; you pay about 20%
  • Platinum: health plan pays 90% on average; you pay about 10%

What metallic level does the Rice Student Health insurance plan fall under?

The Rice insurance plan falls into the Gold category.

Actuarial Value = 83.35%

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