NHS in the UK - need info pretty quickly!

Correcting myself - I said
Maybe yes, maybe no.  The IRS includes "Certain foreign coverage" in its summary of what constitutes minimum essential coverage" (https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Minimum-Essential-Coverage). .....

Hi. Thanks for writing. We've already been down that road - she's exempt from coverage for the ACA on several grounds - 1) her income is too low (not required to file a tax form this year or next year); 2) the cost of the cheapest plan is more than 8.5% of her income; 3) she already is covered in the US by Medi-cal (which doesn't cover her out of state, hence the kerfluffle; and, 4) a little-known IRS clause that says if she was not resident in the USA for 330 days but was covered while she was in-country, she is considered covered for the year.  Any one of those alone excludes her from being required by the Federal Government to comply with ACA. It's, of course, insane in this country to NOT have insurance coverage - you can easily die in a gutter without it.  So having coverage at home is not the issue.

The issue is the period when she is overseas - and it's a University system regulation (NOT a legal requirement, just something they decided to impose on all students starting in the fall of this past year, even ongoing students) we are fighting, not a governmental one. Her travel insurance is great, while she's traveling, and includes repatriation coverage. It will even fly me over there if a doctor there thinks she would benefit by my being at her bedside, should she fall ill. It has "lifetime limits" as far as dollar amounts it will cover, and doesn't cover routine things like birth control, etc., which disqualifies it from being an ACA-approved plan. It's supplemental to whatever other coverage a student is required to have, as a convenience.

I've  forwarded all sorts of pamphlets, etc., to the powers-that-be on campus, and they do not seem to think they are satisfactory. What I really need to find is something that succinctly and officially states that the Scottish NHS meets the provisions of the ACA - that would solve all problems. I am trying the US Health and Human Services, through our congressman now, but that will take some time.

If anyone knows of some official source we can use, that would be really, REALLY, really helpful right now.

Thanks.

Well, I hope not - we'll take legal action if that's the case.  Calling the IRS is not useful - you end up on the phone waiting for hours, and you may or may not get someone who knows anything about the issue, and it will not be in writing in any event. Our Congressman will be of more help, so we'll be contacting him.

Thanks for the ideas, tho.

Well, if the IRS did rank or rate NHS Scotland as being accepted minimum coverage, there would be some sort of paper trail or process they went through to come to that decision. So perhaps buried in the bowels of DC there is an actual case study....which I would think would hold some sort of weight.

But like you say, ultimately, what you have to meet are the internal requirements of the University. You could produce just about anything and they could say that it didn't meet their requirements. On a very basic level, who has the authority to rate these systems against each other?

For instance the OECD studies these sorts of comparisons between countries. I found a report titled How does the NHS compare with health systems in other countries?

It talks a lot about the "universal nature" of UK healthcare....that it covers everything, for everyone, from general taxation....

But would they accept it? No, probably not....it's not a direct side-by-side comparison to California health care.

Now later, if you end up suing these guys, I would think all of these things would be great in a hearing....but they might not do you a bit of good now.

Definitely contact your Congressperson...

PS: If you haven't already, request from them an official concise description of exactly what proof will meet their requirements, and who it should be authored by. It might help curtail their flippant disregard for everything you keep sending them.

Hi. Thanks for writing. We've already been down that road - she's exempt from coverage for the ACA on several grounds - 1) her income is too low (not required to file a tax form this year or next year); 2) the cost of the cheapest plan is more than 8.5% of her income; 3) she already is covered in the US by Medi-cal (which doesn't cover her out of state, hence the kerfluffle; and, 4) a little-known IRS clause that says if she was not resident in the USA for 330 days but was covered while she was in-country, she is considered covered for the year.  Any one of those alone excludes her from being required by the Federal Government to comply with ACA.

Then that's your best line of argument - much stronger than trying to get them to accept the NHS entitlement in lieu.  Her exempt status is based in U.S. law, whereas her NHS entitlement could vanish in an instant if the rules are changed again.

That's the line to press with your Congressman, IMO - by insisting on this insurance coverage, the University would be depriving your daughter of her rights as an American citizen.  Your Congressman may be able to use that - whereas the NHS entitlement would be much trickier.  Or so it seems to me.

Good luck.

Technically the ACA does not force you to have health insurance - that was one of the bases for the Supreme Court's decision that it's not actually a crime not to have health insurance (which would've changed their ruling) - rather it's that you may have to pay higher taxes for not having eligible coverage. (It probably won't matter in the OP's case, but there's nothing illegal about choosing to pay a penalty that is less than coverage you couldn't even use where you are living anyway.)

Good point. 

Then that's your best line of argument - much stronger than trying to get them to accept the NHS entitlement in lieu.  Her exempt status is based in U.S. law, whereas her NHS entitlement could vanish in an instant if the rules are changed again.

That's the line to press with your Congressman, IMO - by insisting on this insurance coverage, the University would be depriving your daughter of her rights as an American citizen.  Your Congressman may be able to use that - whereas the NHS entitlement would be much trickier.  Or so it seems to me.

Good luck.

Hi. Unfortunately, being ACA eligible is not the issue. We actually have no problem with the ACA - considering prior to it she was working all day just to make enough cash to pay the $850 a month health premiums she had to pay, and with ACA she has other options - like being able to go to Uni and still have coverage. The Uni's plan is solid, there's not a lot wrong with it as far as those types of policies go, but they are self-insured and exempt from some of the ACA requirements, and require you to use their facilities. Which is ok, we hope never to need them. 

But our problem remains. We are talking about being forced to pay for it when it's not needed, and the cost being quite high at that. Plus there's a several-thousand dollar "out of pocket" you have to pay on top of the purchase price.  After much cajoling and provision of reference material, now we're to it's the university's interpretation of guidance sent down from the Office of the President (of the University, system-wide) that is the issue. They have arbitrarily mandated that all students have ACA compliant health insurance at all times - even summers when they are not enrolled (which is another issue entirely) - or when they're abroad on a University-related study program. 

She cannot be on my insurance. So that's a moot point. She has coverage while she is here in the states. It does not have an overseas provision, as is the case with most private insurance plans. In any event, since she has the NHS, she doesn't NEED private insurance. We'd even happily pay the NHS for the 5 months of their cover. It's a lot cheaper than the UC insurance.

The list I provided earlier is what was required for proof. They are now  saying it looks like the NHS provides at least the equal amount of coverage... and have changed to the "but what if she takes a trip out of the UK while she's there?".  I parried with the EU has emergency care available and the travel insurance would come in there and fly her home when she's stable. (She's unlikely to need a mammogram while on a vacation trip to France, etc.) But since they've jerked her around on her financial aid package she doesn't have enough funds now to travel for fun anyway - she'll have just enough to be at the Uni and study. No playtime in this package.

I did try to phone our congressman and their phones are out of order locally (we had some rain last night and that plays havoc with phones in some parts of town). I sent a brief email stating the issue and asking if we could get something from some government agency that explains that the IRS or HHS considers the NHS as comparable to the (minimal) coverage required by the ACA, just to have that in writing.

I also let the school know that I contacted the Congressman about this and filled his office in on the issue.

It's my understanding today that this will be discussed with the Office of the (Uni) President early next week.

http://eap.ucop.edu/financialoverview/pages/what-does-study-abroad-cost.aspx

The university makes some interesting claims in its advertising

UCEAP programs typically cost less than other study abroad programs. Because we are a public institution and because we interact directly with campus Financial Aid Offices, we are required to publish program estimates that are as realistic, accurate, and complete with no missing costs or surprises.

So if you have to sue them because of the extra charges you can claim that they misled you ( and everyone else ) by not advising you of the cost up front.

While the agreement with the Scottish university may be new they must have come up against the NHS at some point as they had a reciprocal agreement with York in 2012-13.

According to http://london.universityofcalifornia.edu/students/index.html - the UC London based students website 850 UC students a year study in England and Scotland so you would think they were used to the NHS.

You might even contact them and ask if they have resolved this problem before
University of California Trust (UK)
3 Bedford Square
London
WC1B 3RA

Tel. +44 20 7079 0560

They have some handy email addresses on the staff page

http://eap.ucop.edu/financialoverview/pages/what-does-study-abroad-cost.aspx

The university makes some interesting claims in its advertising

UCEAP programs typically cost less than other study abroad programs. Because we are a public institution and because we interact directly with campus Financial Aid Offices, we are required to publish program estimates that are as realistic, accurate, and complete with no missing costs or surprises.

So if you have to sue them because of the extra charges you can claim that they misled you ( and everyone else ) by not advising you of the cost up front.

While the agreement with the Scottish university may be new they must have come up against the NHS at some point as they had a reciprocal agreement with York in 2012-13.

According to http://london.universityofcalifornia.edu/students/index.html - the UC London based students website 850 UC students a year study in England and Scotland so you would think they were used to the NHS.

You might even contact them and ask if they have resolved this problem before
University of California Trust (UK)
3 Bedford Square
London
WC1B 3RA

Tel. +44 20 7079 0560

They have some handy email addresses on the staff page

Thank you. My daughter was actually there last year for a full year - no problems at all. Used the NHS, pronounced it excellent. The problem is that this year the O.President sent down to all campuses a mandate saying all students must have ACA compliant coverage at all times and that the only coverages were (listed on their website) as several government programs or private insurance purchased in the USA that met the ACA guidelines. There was no provision made for students going to countries with NHS available. The people on campus who "gate-keep" to make sure all the kiddies are in compliance with University regulations are not able to do more than quote it as gospel. And, quite frankly, of all the people I've talked to in the Uni about this in the last week, only one had a clue what the NHS system was, and she even asked me to find out what the coverage limits were. So I don't entirely blame them - one can't be faulted for ignorance. What I do find annoying is that these directives get blasted down the pipeline without anyone vetting to see if a "one-size-fits-all" approach actually DOES fit all. 

We have also requested that if they insist she have this unnecessary extra insurance they cover the cost with financial aid other than loans, since the work-sheet they provided to the kids to figure their budget did not include mandatory insurance fees - that had not been mandatory  until this year.

I'm rather surprised there hasn't been more of an outcry - it's my understanding that the full-year kids have to pay the NHS fee with their visa applications? It's not a lot of money compared to what UC charges for their insurance, but if they are paying both places???

We've done all we can do at present, and it will have to gurgle along. I'm thinking there's going to be a class-action lawsuit at some point about the mandatory summer coverage to pay for the school's insurance while they are not even in town. But who knows? 

I do thank you all for all your suggestions. Fingers are crossed here!   

I think the basic problem is there is no defining single document about what the NHS does, after 70 years I'm not even sure anyone knows.  The services list for NHS Glasgow runs to hundreds of pages.

Perhaps you could turn it around and say if they want you to pay they need to prove that you will get an added benefit of some sort.  Ask for a detailed list of what their proposed cover provides, how it would provide it in Scotland and what they think it would cost there.  You could then show that nothing on their list is not available free in Scotland or indeed if the coverage implementation would have to use the NHS then ask why pay for something free.

Presumably the health cover they require would need to be done under some sort of contract in Scotland - is that in place?

You might also mention that should you have to take out the insurance then there is nothing to stop your daughter mentioning that she is going private to any and all healthcare professionals she meets.  Private dentistry here is expensive.... a bit of grit in the eye - opticians can be expensive in an emergency.

Good luck with all of this - I live just 45 minutes from Glasgow so I know the area quite well, if you need anything else just drop me a message.

I think the basic problem is there is no defining single document about what the NHS does, after 70 years I'm not even sure anyone knows.  The services list for NHS Glasgow runs to hundreds of pages.

Perhaps you could turn it around and say if they want you to pay they need to prove that you will get an added benefit of some sort.  Ask for a detailed list of what their proposed cover provides, how it would provide it in Scotland and what they think it would cost there.  You could then show that nothing on their list is not available free in Scotland or indeed if the coverage implementation would have to use the NHS then ask why pay for something free.

Presumably the health cover they require would need to be done under some sort of contract in Scotland - is that in place?

You might also mention that should you have to take out the insurance then there is nothing to stop your daughter mentioning that she is going private to any and all healthcare professionals she meets.  Private dentistry here is expensive.... a bit of grit in the eye - opticians can be expensive in an emergency.

Good luck with all of this - I live just 45 minutes from Glasgow so I know the area quite well, if you need anything else just drop me a message.

Oh, thanks so much. We appreciate it. Dentistry - don't get me started on what it costs here, or the optician.    The catch with the school insurance is that it only pays 60% of "usual and customary costs" and that she'll be paying 40% of costs on top of the price of the policy, until she reaches an out of pocket expense limit of $3,000 if she uses "in network" providers (how many of those are in Glasgow???) and  $6,000 for out of network!

http://www.ucop.edu/ucship/files/uc-ship-brchr-ucsc-LRproof-072015-web.pdf

Hi. Unfortunately, being ACA eligible is not the issue.

The issue seems to be that the university is using the advent of ACA to justify this onerous requirement for a second insurance policy.  And I would suggest that's the point you may be able to contest, with the aid of your Congressman.

Your daughter's exempt from the ACA requirements, due to low income - in other words, she's one of the citizens ACA is intended to benefit.  The school is violating this intended outcome by using ACA as a pretext for requiring your daughter to pay for an ACA-compliant insurance policy.  The issue should not be proving that NHS provision in Scotland is equivalent to the university's bells-and-whistles ACA-compliant policy.  It isn't, not being intended for that purpose, so if the University chooses, they can easily find grounds of difference to justify refusing to accept it as equivalent.

They might not choose to be that contrary - sounds like you're having some success in persuading them to accept the NHS entitlement as sufficient.  What your Congressman could usefully add, it seems to me, is to point out to them rather emphatically that your daughter, as an exempt individual, should not be forced by her university to pay for an ACA-compliant policy when the law specifically says she doesn't have to pay for an ACA-compliant policy.
[..]

I did try to phone our congressman and their phones are out of order locally (we had some rain last night and that plays havoc with phones in some parts of town). I sent a brief email stating the issue and asking if we could get something from some government agency that explains that the IRS or HHS considers the NHS as comparable to the (minimal) coverage required by the ACA, just to have that in writing.

Having read further, I think the IRS reference to "Certain foreign coverage" may mean coverage for individuals from other countries while they are working in the U.S.  The "Final Rule" entry in the Federal Register gives some commentary about the decisions that were made about what constitutes Minimum Essential Coverage - not only on foreign coverage but also on student health plans - throws a bit of light though not a lot.  (https://www.federalregister.gov/articles/2013/07/01/2013-15530/patient-protection-and-affordable-care-act-exchange-functions-eligibility-for-exemptions#h-44)

I also let the school know that I contacted the Congressman about this and filled his office in on the issue.

Excellent.

It's my understanding today that this will be discussed with the Office of the (Uni) President early next week.

Let's hope they're thoroughly annoyed.

I don't have anything useful to add, but I think you are wonderful for going into battle over this! Your daughter is lucky to have you as her mum

Well, my husband is a retired University of California administrator, and the UC Office of the President accepts that the Scottish NHS covers him (and me) sufficiently not to insist that we have their mandatory Medicare drug coverage.  We've just been through this in detail with them, and they were fine with us opting out of Medicare drug coverage since we live outside the US and are covered by the NHS.  So clearly one end of the UC bureaucracy is not talking to the other end!

The issue seems to be that the university is using the advent of ACA to justify this onerous requirement for a second insurance policy.  And I would suggest that's the point you may be able to contest, with the aid of your Congressman.

...snip...

 
Let's hope they're thoroughly annoyed.

We'll see.    I am not looking to annoy them, particularly, but do not care if they are so. I DO want to get this problem fixed, for my daughter and all the other kids who will be in the same situation. Given that the year-long kids have to pay the NHS fee to the UK with their Tier 4 visas in addition to UC insurance... and that short-term students outside of Scotland in the UK have to pay a fee or pay for NHS, there's a lot of student money involved here. Maybe not a problem if mommy and daddy are paying the bills, and are wealthy. But for the rest, it's a substantial problem.

If there are 800 students going from UC to the UK, at about $2000 a full year they pay for UC insurance, UC stands to lose... a cash cow. Not a large one, but it's a chunk of change. I'd prefer to think that is NOT what they are doing this for, so I'm sure they want every penny they can get. My assumption is that most of these kids are on mommy and daddy's insurance anyway, so it's  a moot point for them - as long as mommy and daddy's insurance covers them overseas. (Not all plans do, so if these kids are on one of the typical "Covered California" plans, they'll be in the same situation).

The U has no legal grounds to require insurance under the ACA; however, they CAN require that students have insurance to be enrolled. (Still not sure they can require it over the summers, but that's not our fight here.) Many universities make that a requirement for enrollment. Since the guidance actually came, I believe, out of the Risk Management department, this is more about UC's Liability than any real concern for the students, I think.

As with most things related to the EAP program, they rolled this change out very badly, very very badly. The one comment I finally got from an EAP spokesperson at the Uni was "Well, we put the change up on our website and told the kids to be sure to read our website when they were selecting their programs."  My daughter sat through two in-person group orientations where them not accepting NHS was not mentioned, she participated in a session where she was an invited guest and discussed her travel and time in Scotland with students who were going - in which she explained how the NHS and Travel Insurance worked since the person running the session did not know. At NO time was there ever a discussion of the issues we're having now. The "expense" budget worksheet they were given did not have a category on it for "insurance" - they just used last year's form (from when it was not required). So the extra 750-ish pounds was neither planned for nor is in her budget right now - she will have to borrow to cover the expense if they insist.

As I told the Uni EAP rep: who in their right mind would automatically assume that the NHS of a first world country would NOT be considered as equivalent to our rather pathetic Medicaid system (which is grounds for exclusion)? I got no reply - that happens a lot at this Uni, which is how I ended up involved in the first place. My daughter made several phone calls, left voicemail messages, and got no call-backs, (EAP and the insurance office people). Enter me. I made half a dozen phone calls and was bounced from office to office, and then back to the person who had denied the petition in the first place.  I had to go to the head of the division to get someone to contact me to let us know who we COULD discuss this with rationally. It's moving now, so we'll see how it goes next week.

Well, my husband is a retired University of California administrator, and the UC Office of the President accepts that the Scottish NHS covers him (and me) sufficiently not to insist that we have their mandatory Medicare drug coverage.  We've just been through this in detail with them, and they were fine with us opting out of Medicare drug coverage since we live outside the US and are covered by the NHS.  So clearly one end of the UC bureaucracy is not talking to the other end!

SOOOO Typical.