The SHIP Disadvantage: Why Schools Should Separate International and Domestic Student Health Plans

Posted on Friday, September 5th, 2025 at 3:19 pm

When schools think about student health insurance, a common assumption is that “one plan fits all.” At first glance, combining international and domestic students into a single SHIP (Student Health Insurance Plan) might feel like the simplest solution – one plan, one administrator, less hassle. There may also be an argument made for “equal” coverage, so all students are “treated the same”.

But here’s the reality: what may seem like administrative efficiency can actually create significant barriers for your international students, and they may not benefit equitably from such a plan. By merging these students, you risk higher costs, fewer options, and reduced accessibility to the very students who may need support the most.

This blog explains why schools should carefully consider offering a separate plan designed specifically for international students.

A Quick Refresher: The ACA vs. International Student Needs

While this is great for domestic students, it might be more comprehensive than what international students, who are temporary, non-immigrant visitors, need.

• Unlimited coverage
• No waiting periods for pre-existing conditions
• Maternity care
• Preventive services at no cost

While this is great for domestic students, it might be more comprehensive than what international students, who are temporary, non-immigrant visitors, need.

In fact, the Department of State (DOS) requirements for J visa holders, signed 5 years after the ACA came out in 2015, reflected this difference: much less comprehensive coverage was required, signaling that short-term visitors don’t need the same level of long-term benefits as U.S. citizens. For F and M visa holders, requirements are left to each school, giving institutions flexibility to set their own standards.

Why Combining International and Domestic Students Is a Problem

When domestic and international students are placed on the same SHIP plan, three major disadvantages surface:

1. Higher utilization = higher cost.
   Domestic students tend to use their insurance more frequently. That higher utilization drives up the overall cost of the plan for everyone – including international students who generally use services significantly less often.
   
2. Mandatory ACA compliance.
   Including domestic students forces the plan to meet ACA standards. While important for U.S. students, these standards add unnecessary benefits (and cost) for international students who don’t need unlimited lifetime maximums or such comprehensive benefits.
   
3. Bigger out-of-pocket burden.
   To offset the high cost of comprehensive coverage, ACA/SHIP plans often come with steep deductibles, coinsurance, and copays. For international students – many of whom struggle to understand the U.S. healthcare system in the first place – these expenses can discourage them from seeking care at all.

In short: international students end up subsidizing a plan designed for domestic needs, while paying more and getting less.

The Case for a Separate Group Plan

When schools separate populations into two distinct plans, they gain flexibility to:

• Customize coverage. Add benefits essential to international students, such as emergency medical evacuation, repatriation of remains, and 24/7 travel assistance.
  
• Lower overall costs. Design benefits that reflect actual student needs, like capped or excluded benefits that can be handled at home or at the student health center – or that are generally unnecessary.
  
• Reduce out-of-pocket barriers. By tailoring deductibles, copays, and coinsurance, schools can make care more affordable and accessible.
  
• Provide meaningful support. Plans can include multilingual services, cultural guidance, and dedicated resources to help students understand networks, claims, and care options.

Instead of forcing international students into a one-size-fits-all model, a separate plan respects their unique needs and improves their overall experience on campus.

Why It Matters

High premiums and confusing cost-sharing structures not only impact international student well-being – they also affect enrollment. If international students feel unsupported or priced out, it could reduce your institution’s ability to attract and retain them.

By designing a plan tailored for international students, schools send a strong message: you are valued here, and we’ve thought about your unique needs.

TL;DR

• SHIP/ACA plans are not designed with international students in mind.
• Combining domestic and international populations raises costs and out-of-pocket expenses.
• Separate group plans give schools flexibility to provide cost-effective, culturally sensitive coverage that meets international students where they are.

Recognizing the uniqueness of your international students isn’t just about compliance, it’s about making sure students have what they need to succeed.

Ready to explore group insurance options tailored to your international students?

We’d be happy to partner with your school to design a plan that supports your international students and scholars while they are here in the US. [Request a Quote]