Students from outside the United States who choose to study at Southeast Missouri State University or other American universities are faced with many challenges, not all of them immediately apparent. Among these challenges is a part of life often taken for granted by college students: the cost of health care.

The Affordable Care Act (ACA) of 2010 affected millions of Americans and how they receive their healthcare. One provision of the law allows children to remain on their parents’ insurance until their 26th birthday. The law also forbids insurance companies from refusing to insure an individual based on pre-existing conditions. For those international students deemed “nonresident aliens” by the IRS, these requirements do not apply — this may or may not be a bad thing.

Ef Sidiropoulos, assistant to the executive director of International Education Services, said Southeast requires international students to acquire medical insurance coverage through the university. University policy dictates that every three years the university outsources a bid for insurance companies to offer medical insurance to international students.

“And just because of the [Affordable Care Act] and that really affecting and driving premiums, we've actually been doing it on an annual basis,” Sidiropoulos said.

Because the insurance policy does not necessarily have to comply with ACA requirements, the university has greater freedom to choose coverage options that will best cover international students at the best price.

“That gives us more leverage as far as determining [the] type of coverage that we want,” Sidiropoulos said. “And ultimately try to make sure that they have coverage to meet needs if they were to get sick and have emergency situations.”

Currently, international students at Southeast are insured by a company called LewerMark. The company specializes in providing international and study-abroad students with medical insurance while they are away from their home countries.

The cost for this insurance coverage comes out to about $103 a month for international students, though it is billed per semester. The policy includes a $0 copay for the campus clinic, $25 copay for off-campus physicians and a $100 copay for emergency room visits. Compared to ACA compliant individual plans, which includes premiums that can vary from $200 to $400 with varying copays, international students who become American citizens often see a sharp increase in the cost of their medical insurance.

Sidiropoulos said apart from the financial side of American health care, international students must also contend with a radically different health care system at large.

“One of the biggest challenges for most international students, and for most scholars and students, is that our healthcare system is set up quite different from most countries,” Sidiropoulos said.

Sidiropoulos said in many countries, pharmacists are able to write prescriptions without doctors’ diagnoses. Additionally, the idea of the emergency room is new to many international students who are not used to regular physicians having offices away from the actual hospital.

With these and other differences between the health care system of the United States and other countries, international students must learn what facility best suits the seriousness of their injury or illness. Sidiropoulos said in the past the insurance policy offered to international students included no copay for emergency room visits and would sometimes result in students accruing several thousand dollars in bills, when other much cheaper options were available.

The insurance plan also covers global evacuation for the insured, meaning reasonable travel expenses would be provided if adequate medical facilities were not immediately available. Additionally, compassion visits and repatriation costs are covered by the policy.