The enrollment method a school chooses has a dramatic impact on the cost and benefits of its student insurance plan.

Because student health insurance is a highly specialized field, there are very few insurance companies who cover student health.  Most carriers that do underwrite student health insurance typically require a forced enrollment method as described above.  This is especially true for smaller schools.  Why?  The simple answer is economics.  The premium collected at a smaller school under a voluntary enrollment method barely covers the costs of the plan.

You may have seen voluntary plans already in existence and wondered why such a plan is not available for your school.  Voluntary plans currently in existence often fall into one of the following groups:  (1) Old-Timers.  Many student plans have been in existence for quite a while and have proven profitable for the insurance company.  As long as the claims are low, the companies will renew those plans but will not underwrite new ones;  (2) Shelf Plans.  Some insurance companies create policies with limited benefits which they offer to any and all schools which are interested.  These boilerplate "one-size-fits-all" plans are called "shelf plans."  Not surprisingly, they feature very limited benefits and high premiums.  However if you are a small school that is unwilling to consider a Mandatory or Hard Waiver enrollment method, this may be your only option.

Mandatory and Hard Waiver plans are the future of student insurance.  Their primary benefits are:

1. The increased participation allows for a major savings in premium cost due to a larger pool of insureds over which to spread the risk.  This is especially important now that the Office for Civil Rights has declared that coverage for maternity will be required on all college sponsored plans under Title IX.  The amount of savings is directly proportionate to the strictness of the enrollment methods.
2. The increased participation allows for major savings in premium cost due to the elimination of "adverse selection," primarily high risk or unhealthy students choosing the plan.
3. The carriers in the Student Health Insurance field are either reluctant or unwilling to provide bids for small or medium-sized colleges that have a non-mandatory or waiver enrollment system.  This is simply a matter of economics - not enough money coming in as premium and too much money going out as claims.
4. The increased participation also allows for a Plan Design which offers better benefits.
5. Establishing a predictable and stable premium base avoids the "tailspin" that plans sometimes develop as premiums rise and participation decrease. Unfortunately these problems often fuel one another.

DETAIL OF ENROLLMENT METHODS

I. Forced Enrollment Methods. 

For both of the following methods, the premium is collected through the tuition billing process with a list of insureds and premium submitted by the school to the agent.  Typically a brochure and explanatory packet are sent to the student with all other tuition billing materials:

Mandatory.  All students are automatically covered under the plan with the premium included in their tuition billing.

Hard Waiver.  All students are billed for the premium on their tuition billing.  Students who return a Waiver Card certifying the existence of comparable in-force coverage by the deadline (typically Registration Day), may deduct the premium from the tuition owed or will be refunded the premium.

II. Voluntary Enrollment Methods. 

For both of the following methods, the premium is collected directly from the student to the agent.  Typically, a brochure and explanatory packet is sent to the student's home address with an Enrollment Card that may be completed and returned.

Voluntary.   All students are sent a complete packet with a brochure and Enrollment Card at their home address six to eight weeks before registration.  Students wishing to purchase the plan return the Enrollment Card along with the correct premium amount to the agent.  The agent maintains up to date lists of insureds.

Soft Waiver.  All students are required to either submit a Waiver Card showing the existence of comparable in-force coverage or enroll in the plan by returning an Enrollment Card and correct premium directly to the agent. However, there are no consequences for failing to do so.  In some cases, the Soft Waiver is incorporated into the registration process, and students are required to either enroll or waive coverage before their registration is complete.

III. Hybrid Methods. 

Schools may use a combination of the above enrollment methods based on:

Type of Coverage.  Many schools feature plans which have Mandatory Accident/Voluntary Sickness or other such hybrid plans based on the type of coverage.

Student Status.  Many schools feature plans which are Mandatory Undergraduate Students/Voluntary Graduate Students or other hybrid plans based on the student's status.  Other distinctions include Domestic/International and Resident/Non-Resident.

Summary of Enrollment Methods

Mandatory
Are students billed the premium?	Yes
If so, How?	On Tuition Billing
May students waive the premium?	No
Enrollment and Premium	List of insureds and premium sent by school
Hard Wavier
Are students billed the premium?	Yes
Is so, How?	On Tuition Billing
May students waive the premium?	With proof of other coverage
If so, How?	Waiver sent to school
What effect does waiver have?	Premium may be withheld or will be refunded
Enrollment and Premium	List of insureds and premium sent by school
Soft Waiver
Are students billed the premium?	Yes
If not, how is Plan solicited?	By direct mail
Must the student respond?	Yes - enroll or waive
What if he/she does not?	No real consequences
Will student ever be billed?	No - only encouraged
Enrollment and Premium	Student sends  to Agent
Voluntary
Are students billed the premium?	No
If not, How is Plan solicited?	By direct mail
Must the student respond?	No - purely optional
Enrollment and Premium	Student sends to agent