Waiver of Participation Due to Comparable Coverage

(1) Election of Waiver of Participation. A School may elect to allow full-time and part-time Students to waive participation in their School's Student Health Insurance Program. Schools electing to allow waivers must: (a) clearly communicate to their Students information regarding the waiver process, the manner by which a Student may request and obtain a waiver, and the deadlines associated with the waiver process. (b) require Students waiving participation to certify, in writing, at least annually, as part of the School's usual registration process that they are participating in a Health Benefit Plan with comparable coverage pursuant to 956 CMR 8.05(3). (2) Comparable Coverage. (a) Coverage under a Health Benefit Plan is comparable if: 1. the Health Benefit Plan provides to the Student throughout the School Year 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. the services covered under the Health Benefit Plan, including all services listed in 956 CMR 8.05(2)(a)1., are reasonably accessible to the Student in the area where the Student attends School. (b) School permitting Students to waive participation in its Student Health Insurance Program in accordance with 956 CMR 8.05(1) must waive participation for Students enrolled in a subsidized Health Benefit Plan through the Connector or enrolled in MassHealth., with the exception of those MassHealth programs identified in 956 CMR 8.05(2)(c)1. (c) A School may not waive participation for: 1. Students determined to be receiving services paid for by the Health Safety Net or Students enrolled in MassHealth Limited or the Children’s Medical Security Program; 2. Students with coverage from insurance Carriers outside the U.S. and coverage by foreign National Health Service programs, unless the Student is studying in a foreign country and the Student's insurance provides coverage in that location; and 3. Students with a Health Benefit Plan that provides coverage through a closed network of providers, not reasonably accessible in the area where the Student attends School, for all but Emergency Services. (d) A School may establish additional criteria for plans to be considered comparable so long as the as the minimum requirements of 956 CMR 8.05(2)(a) are satisfied. (e) It is the responsibility of the Student seeking to waive participation in his or her School's Student Health Insurance Program - not the School in which the Student is enrolled - to determine whether the Student's Health Benefit Plan has comparable coverage as defined in 956 CMR 8.05(2). (3) Written Waiver Request. (a) A School electing to allow Students to waive participation in the School's Student Health Insurance Program, or such School's designated representative, must obtain, from each Student, a written waiver request. The waiver request must be on a form supplied by the School, and may be supplied to Students, as well as submitted, electronically. Schools may also administer a waiver request through an online process. The waiver request must contain, at a minimum, the following information: 1. the name of the entity offering the Health Benefit Plan; 2. the policy or other number used to identify the Student's participation in the Health Benefit Plan; 3. the subscriber or primary enrollee in the Health Benefit Plan and the relationship of that person to the Student; 4. a statement certifying that the coverage under the Health Benefit Plan is comparable to coverage under the School's Student Health Insurance Program and that the Student understands that once a waiver request is submitted, the Student will be responsible for his or her medical expenses, and that neither the School nor the Student Health Insurance Program will be responsible for those expenses; and 5. a signature of the Student and the Student's parent or guardian if the Student is a minor. A School may accept electronic waiver forms and electronic signatures. (b) A School has no affirmative obligation to compare coverage of the two plans. If a School relies in good faith on the statements by a Student that the coverage is comparable, the School is not liable for any penalty or for any failure to comply with a provision of 956 CMR 8.00 caused by any misstatement by the Student. A School must not accept a Student's waiver request, however, if it knows that the Student's statement is inaccurate or if the Student's coverage cannot be verified. If a School does not accept a Student's waiver request, the Student must participate in their School's Student Health Insurance Program.