Assurance of Insurance: Health insurance from good intentions puts financial burden on international students

Summer 2022 was slowly reaching its end as August approached, and Central Michigan University students began to prepare for the fall semester to come. Across the globe, 1,121 CMU international students were getting ready to take flight to America, excited for the journey to come -- until $638.40 was charged to their student billing account Aug. 12. 

A mandated health insurance policy for international students took effect that day. All international students were automatically enrolled in a 12-month premium plan, and were told they would be charged $127.68 per month, per individual, or $1,532.16 per year, through their CMU student billing account, according to the Office of Global Engagement.

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Therefore, if a student carries family members, they will be charged for each dependent on the insurance. 

GeoBlue, provided by Blue Cross Blue Shield Network, was the selected health plan provider. 

The possibility of a mandated health insurance policy for international students was announced during international students’ Fall 2021 orientation, Executive Director of Office of Global Engagement Jennifer Evanuik said.

Shortly after, the policy had been approved between October and November 2021.

Himal Roka is currently a Ph.D. candidate in the lab of Dr. Xantha Karp in the Biochemistry, Cell, and Molecular Biology program in the College of Science and Engineering. He is originally from Nepal. 

Over a month ago, Roka approached Central Michigan Life about CMU’s mandated health insurance policy. Since then, he has written a guest column for CM Life, worked with a group of students to put together an online petition and created a survey for international students to voice their opinions on the policy. 

In Roka’s guest column he said the recent change in CMU’s health insurance policy places an unfair burden on international students.

 “Although CMU's health insurance program is intended to protect the well-being of international students, the cost of this new insurance plan hurts us financially, mentally and emotionally. International students from low- and middle-income families find it challenging to maintain the standards of life, given the increasing cost of tuition and additional costs of living in the U.S,” he said. 

In 2010, 25 out of 600 international students said the same thing in a protest on campus; the mandated health insurance policy that was being implemented at the time was an “unfair burden,” according to Central Michigan Life archives. 

How was this communicated to students?

The majority of the communication between the university and international students regarding any updates on the policy was through email. However, on behalf of the university, Executive Director of Communications Ari Harris said the information was also provided to students during their orientation, as well as at a meeting for international students in September.

"Email is the official form of communication at CMU and a majority of the communication was by email to the student’s cmich.edu account," Harris said. "The OGE website also was updated with this information."

In December 2021, the first official announcement for the upcoming health insurance policy was made. Harris said it was a note that was sent by the ISO to all enrolled international students to announce that the Office of Global Engagement would be sharing information about a health insurance plan in Spring 2022. That message also included a link to a document that allowed students to submit questions about insurance, she said.

Neuroscience major Carolina Hernandez Ruiz, a second-year international student from Spain, is an inclusion assistant in Celani Hall. She said it was very annoying to learn that the payment for the policy would be taken out of students' billing accounts, because that requires students to have to pay for it no matter what. 

"If students don’t pay their student account, they cannot register for classes, therefore they cannot come here," she said.

On Feb. 1, the Office of Global Engagement sent an email to all international students to officially announce that the mandated health insurance plan was to commence the following school year. The email also included a link to the FAQ page for further details.

Executive Director of Global Engagement Jennifer Evanuik said when CMU announced the policy on Feb. 1,  that was also when risk management was getting the Requests For Proposal (RFP) from different insurance companies and entering into negotiations. It takes time because: "There (are) a lot of details on what's included, what's not, what your copay is, etc.”

“So once that was settled, that was then also announced to the students," Evanuik said. "So everything didn't come all at once because we didn't have everything all at once, but it was better to say, ‘okay, this is what we know at this point, this is what this is going to look like.”  

Harris said that making the decision to implement a policy "had to proceed the choice of a plan."

"That policy decision is what initiates the Request For Proposal (RFP) and bidding process, in which several vendors have the opportunity to present plans and prices to CMU," Harris said. "CMU requested and reviewed multiple bids from plan providers; the university considered 11 plans before selecting an option (a plan offered by GeoBlue) that was both  (Affordable Care Act) ACA-compliant, ensured students could not be rejected due to pre-existing conditions, and was offered at a price point comparable to our peer institutions."

On April 19,  Nakajima sent an email to all enrolled international students that explained the cost of the plan would be $1,532.16 and that the cost of the plan would be divided into two payments, billing a portion in the fall ($638.40) and the other in the spring ($894).The difference in payment is due to the way the calendar year splits, Harris said. 

The email sent on April 19 also included a student member guide outlining the plan benefits and other information, as well as an invitation to the virtual town hall meeting that was scheduled for April 26. 

"The urgency to implement the plan was based on CMU’s commitment to protect the health and safety of its students – the plan needed to be in place prior to the start of the school year so that students were covered immediately as they began their studies at CMU," Harris said.

Students had four months until their student accounts would be billed.

Nakajima sent out an email reminder to enrolled international students April 25 for the virtual town hall meeting. The meeting itself included information about the insurance provider for the policy. GeoBlue representatives were present, as well as the Office of Global Engagement and student health center, to answer questions from students, Evanuik said.

Two additional information sessions were held during international students' required orientation session Aug. 25 and a meeting for international students Sept. 13, Harris said.

Hernandez Ruiz said she didn’t know about the meeting until running into her friend at Starbucks 30 minutes prior. She did not receive an email regarding the meeting; however, her friend did.

“I went to the meeting and surprisingly, there were only like 15 people,” Hernandez Ruiz said. “And I think it was such an important meeting because [they’re] actually going to explain what GeoBlue means, what is the health insurance and stuff. But barely [any] one was there."

History repeats itself

According to Central Michigan Life archives, 25 CMU international students gathered on campus in 2010 to protest the new mandated health insurance policy. Students carried signs that either asked for semester-based insurance or criticized the new policy as they walked from the library to Warriner Hall shouting, “This is my health, not the university’s.” 

The CMU Student Injury and Sickness Insurance Plan required students to pay one year for health insurance right away. There were about 600 international students on campus at the time, and many of them felt the policy was an unfair burden on them, according to Central Michigan Life archives.

Students created an online petition that was signed, in addition to the protest, but they said they just didn't have the manpower. 

However, according to archives, Tom Trionfi, director of contracting and purchasing services at the time said several discussions were held with international students and university leadership groups in order to create a more affordable insurance plan. 

CMU revised the policy shortly after the protest to provide students with the option for outside coverage, along with allowing students to pay for single-semester coverage. 

What does faculty think?

“We are all here to take care of students," Fornari said.

According to reports from OGE, there are 1,121 international students on campus this semester. That’s 230% higher than last year. 

Fornari said that there are a lot of international students in the department of physics. He had been paying attention to the health insurance for a very long time, and always encouraged students to get health insurance. However, he is not "really fond" of the mandate.  

The GeoBlue Premium plan costs $50 more per month than what the students in average were paying for their health insurance plans prior, Fornari said. CMU picked a plan where students, regardless of the age, pay the same price. 

“$50 more of expenses per month doesn’t look a lot,” Fornari said, “But in 12 months it’s the money to pay for a ticket to go home.” 

Fornari believes CMU had good intentions when proposing health insurance to the students. However, the biggest problem was the lack of communication on the university's part. 

“The students, even undergraduate students, are adults," he said. "They deserve a respect at least to have a conversation."

Fornari proposed that the issues regarding the mandated health insurance policy be resolved by an open and honest exchange of information. 

Associate Biology Professor Xantha Karp said she agrees with the idea of having health insurance for international students. She believes it is important to have health insurance and that it is more expensive to not have health insurance in America.

“But I'm really not happy with the way this particular one rolled out,” Dr. Karp said. “I think it needs to be affordable for the students. I know that the amount of money is a hardship."

Dr. Karp is Roka’s academic advisor and one of his Biology professors. She said that working in the biomedical science graduate program is a full-time position – mostly research and some teaching along the way. In addition, graduate students are given a living stipend which comes from research assistantships or teaching assistantships. 

Dr. Karp said Roka is currently under a research assistantship, and neither of them have any control over how much his stipend is. However, the health insurance is a significant percentage of that.

“It's just hard to have that dropped on him,” Dr. Karp said. “And … three of the four graduate students I have in my lab … are international students. And so this policy affects all (of them), and I'm sure it affects the undergrads, too, in different ways. But for the graduate programs, that's the money that they have to work with.” 

Dr. Karp wasn’t aware of the health insurance policy until Himal had brought it up to her. She said when she was told about the policy she checked her email and saw something about it from June, but other than that there was nothing that was highlighted to her. 

“I do believe that those offices, that their goal would be to do something that students are happy with,” Dr. Karp said. “And I don't know what the disconnect is, but it seems that clearly they didn't reach enough of them (students) to understand whether this would be affordable, especially with no real exceptions granted and without the ability to use another health insurance that you already have.”

International students have been one of CMU’s areas of growth, Dr Karp said. Therefore, this policy could make it more difficult for students to come here. 

“I wish that it had been done really thinking of those students and the breadth of the different financial situations of those students,” Dr. Karp said. 

Currently, Dr. Karp is looking into external grants from the National Science Foundation, which are usually for research funding. Instead, they are potentially going to be used to help the international students in Dr. Karp's lab to cover their health insurance costs. 

“That seems to be the only possible way to actually get money to these students this year, is if faculty can individually find pockets of money to give to them,” she said. “And the hard thing is that that money wasn't meant for those purposes. And then I think ‘I don't want my students out there not paying rent because they have these other expenses.’ So it is something I want to look into to see if I can do anything.”

However, as for long term strategy, if it grows more expensive to bring in international students than domestic students, that de-incentivizes faculty to bring international students into their labs, Dr. Karp said.

“It’s great if (university officials) want to offer (a policy) that they think is a good deal, but it should not be only that,” she said. “And it really does need to be the best deal. Which again, I don't know the data behind, but if this really is it, I'd want to see all of that.”

Domestic Student Health Insurance Policy

Albert Nowak, a health administration professor at CMU, said it is important to understand that unlike many other countries in the world, America doesn’t have a health care system.

“There is no system,” he said. “We do more of disease management.”

Citizens who do not have health insurance, but need to get health care and are seeking for a cheaper price, can see community health care centers that receive increased money from Medicaid, Nowak said. One in Isabella County is Isabella Citizens for Health.

Nailya Delellis, a CMU health administration professor, said the challenge also hides in finding a doctor who would take your health insurance. What Medicaid covers is relatively standard, she said. However, employer-based insurance plans vary. 

Delellis compared the necessity for international students having coverage while attending the university to Americans travelling abroad. She said the "host country" wants to be sure that students have some kind of support if needed. When entering the United States as a student or as a tourist, you have to have proof of insurance. 

In addition, unlike international students, American students may be a little more familiar with the health policies in the U.S., Delellis said. 

A lot of American students in Nowak's classes say they are covered by their parent’s health insurance (until they are 26) or by Medicaid (state funding available for people with a low income), Nowak said. 

Unlike for international students, American students are not mandated to have a health insurance plan to go to CMU, or to have an insurance plan provided by CMU. Exceptions are student athletes or students who are doing internships, Nowak said. 

Lana Ivanitskaya, a professor of health administration, has chaperoned students to Sweden, Germany, Switzerland and Canada since 2015 as part of the study abroad program. 

She said students get the GeoBlue insurance plan for the time of their Study Abroad program. It is automatically charged to their student account. A very important service it covers is medical evacuation. 

“There is a lot of risk when you travel,” Ivanitskaya said. “It (health insurance) gives me confidence. A service of being transported to my home country is very important to me.”

Ivanitskaya hasn’t had any experience with her students using health insurance when travelling, but if a student were to get sick abroad, a chaperone would have to stay with them for that time. Hospitals abroad would ask to pre-pay for services; and American health insurance would reimburse the policyholder. 

Ivanitskaya personally used medical emergency services in Canada and Sweden. In Sweden the care was free for her, but in Canada, Ivanitskaya had to prepay and after requesting for reimbursement, American insurance covered her charges.

Federal laws regarding international students

According to International Student Insurance, international students are not subject to the Affordable Care Act (ACA), a U.S. federal law.

Signed into U.S. law in 2010, the ACA, also known as Obamacare, requires individuals to have “minimum essential healthcare coverage.” Those who are not covered will have to pay a fine to the Internal Revenue Service (IRS) when paying taxes.

Non-residents, including international students or scholars with F, J, Q, or M visas do not need coverage that is compliant with ACA standards, according to the International Student Insurance website.

Nevertheless, schools may require international students to enroll in the school plan or other ACA-compliant coverage, due to the benefits being more comprehensive. 

“I think if you're coming from most other countries in the world, it's kind of overwhelming, and it's almost like you don't know what you don't know,” Evanuik said. “And we don't have socialized healthcare. … Many countries do have more available in either free or low-cost services or clinics that you would just go use. But we don't really have that here to the same extent.”

Evanuik explained most international students at CMU have student (F-1) visas and are considered nonimmigrants. This means they are not eligible for public assistance. Therefore, resources such as Medicaid aren’t available. 

“So it does then become the responsibility of the individual to either get insurance or have funds to cover their own medical expenses,” Evanuik said. “That is something that we think about when we're working with the international population, is, how can we help?”

Another burden for international students is work limitations; therefore it is harder for international students to support themselves financially. 

“There is a big limitation when it comes to working on campus as an international student,” Elaswad said. “You are only allowed to work up to 20 hours a week. And that’s (with) minimum wage.”  

Hernandez Ruiz is grateful for her job as an inclusion assistant because it provides her with dorm housing. However, she mentioned that there are students that don’t have that luxury and those that live off of campus. 

“They have to pay for their housing (and) have to pay for their food," Hernandez Ruiz said. "They may have their kids here. On top of those things, they have to study because that's why they're here. And on top of that is this health insurance."

According to the U.S. Citizenship and Immigration Services website, F-1 students are not allowed to work off-campus during their first academic year. However, they can work on-campus under certain conditions and restrictions. Once F-1 students have completed their first academic year, they may work off-campus in three types of employment:

• Curricular Practical Training (CPT)
• Optional Practical Training (OPT) (pre-completion or post-completion)
• Science, Technology, Engineering, and Mathematics (STEM) Optional Practical Training Extension (OPT)

F-1 students may also be eligible to work off-campus if they are able to prove severe economic hardship or special student relief. According to U.S. Citizenship and Immigration services, M-1 students may engage in practical training only after they have completed their studies. For both F-1 and M-1 students, any off-campus training employment must be related to their area of study and must be authorized prior to starting any work by the schools authorized personnel that maintains the Student and Exchange Visitor Information System (SEVIS).