Strong Foundations for Student Health Insurance: Basics for Running a SHS Insurance Program

1. Strong Foundations for Student Health Insurance: Basics for Running a SHS Insurance Program Ann McMican MS Assoc. Director, UHS, University of Rochester Doreen Perez MS RN BC Director of SHS UNF Virginia Stewart BA Manager Health Compliance FSU ACHA Chicago 2012

2. Insurance Changes • www.youtube.com/watch?v=sShMA85pv8M

3. Foundations of SH Insurance • Student Health Insurance can be customized for each school. This presentation will describe and highlight the basic foundation of Student Health insurance at 3 universities: Small, Medium and Large. • We will also address the pros and cons of mandatory vs. voluntary plans • Consortium Building and • Plan strengths and short comings.

4. University of RochesterAnn McMican

5. University of Rochester Ann McMican • Small-Medium size (10,000 students) private research University in sunny Rochester, New York • 50% undergraduate, 50% graduate students • Six decentralized schools. • Main College Undergraduate & Graduate campus • Also includes Medical and Nursing Schools, Simon School of Business, Warner School of Education and the Eastman School of Music • University Health Service –provides pre-paid access to primary medical and mental health care using a mandatory health fee • Health Insurance requirement for all full time students using a hard waiver process for 40+ years

6. University of Rochester Ann McMican Student Health Insurance – Customer Focus An inflammatory article in the “Campus Times” student newspaper led the President to ask for a review of student health insurance. Preliminary Points: • Essentially unchanged since 1970 • Same carrier for >40 years (Excellus BCBS) • Now an outlier compared to other student insurance plans due to lack of prescription coverage • UR graduate students calling for better coverage

7. University of Rochester Ann McMican Customer Focus – Review Process Steps • Benchmark with UAA conference schools • Comparison with ACHA Standards • Graduate student focus groups • E-surveys (Grad & undergraduate students, Parents) • Request For Proposal Evaluation to UR Leadership

8. University of Rochester Ann McMican Customer Focus - UAA Benchmark Results • UR had one of the lowest total annual health fees • UR is the only institution to allow spouses/domestic partners to participate at the student rate. • The UR plan did not cover prescription medications other than diabetic supplies. This accounted for the low insurance premium to a significant degree. • UR did not have a good option for insuring international student families with children who are not eligible for NYS public programs.

9. University of Rochester Ann McMican Customer Focus - ACHA standards for student health insurance were met in all but one category • The UR plan did not provide prescription coverage

10. University of Rochester Ann McMican Customer Focus - Focus Group Themes • Prescription medication coverage needed • Better out of area coverage needed • More affordable options for students with children • Everything should cost less

11. University of Rochester Ann McMican Customer Focus - E-Survey Results If prescription coverage were added, what’s the largest acceptable premium increase? Grad Undergrad Parent I can’t pay any more 42% 57% 67% Could pay $350 more 30% 36% 29.5% Could pay $850 more 6% 6% 2% Could pay $1350 more 2% 1% 0.4%

12. University of Rochester Ann McMican Customer Focus - E-Survey Results What prescription deductible is reasonable? Grad Undergrad Parent 0$ (no deductible) 38% 36% 31% $250/year 45% 46% 49% $500/year 7% 9% 11% $1,000 10% 9% 9%

13. University of Rochester Ann McMican Customer Focus - E-Survey Results My annual prescription costs are: Grad Undergrad Parent 0 to $100 52% 62% 55% $101 to $500 34% 27% 32% $501 to $1,000 8% 7% 9% More than $1,000 6% 5% 3%

14. University of Rochester Ann McMican Customer Focus – RFP process • A “Prescription for Change” • Added Rx to plan requirements • Used $250 deductible, unlimited coverage and three tier co-pay plan • Required a 30% increase in premium

15. University of Rochester Ann McMican Customer Focus – Outcomes • Students are extremely happy with the added prescription coverage • More students have subscribed to the plan • The cost will go down for everyone as this trend continues • A student with Hemophilia A was able to attend UR successfully – Medication costs > $190,000/year.

16. University of North Florida 16,000 Students

17. University of North Florida Doreen Perez • History of insurance at UNF • The Lean years • The Abundant years • The Death Spiral • The Building of a Consortium • The New ACA Benefits

18. University of North Florida Year Number enrolled Cost • 2011-2012 200 Int 38 Dom $ • 10-11 200 Int 198 Dom $ 1295 Bollinger • 09-10 200 Int 300 Dom $1105 BC/BS • 08-09 200 Int 250 Dom $950 $976 BC/BS • 07-08 200 Int 200 Dom $823/ $876 BC/BS • 06-07 200 Int 200 Dom $883 BCS

19. UNF • The Lean Years • 1987 to 1999 • We had inexpensive policies and limited benefits

20. UNF • The Abundant years • 2009-2010 – Blue Cross and Blue Shield (Collegiate Risk Management)-Selected by Insurance Committee • Domestic Students (Voluntary Plan) $1,105.00/year • International Students (Hard Waiver Plan) $1,105.00/year • Excellent coverage/No limits • Loss Ratio of 146% resulted in increased premium of over $3,000 for 2010-2011 year, therefore the insurance committee voted to choose another Insurance Company • 2010-2011 – Bollinger (Collegiate Risk Management)-Selected by Insurance Committee • Domestic Students (Voluntary Plan) $1,295.00/year (+/$190.00 increase) • International Students (Hard Waiver Plan) $1,295.00/year (+/$190.00 increase) • More out of pocket expense for students • Many student complaints regarding customer service • Less Discount with local hospitals, labs & X-ray Services • Denied many of the claims/Difficulty getting them to pay claims • Did not receive accurate claims reports and records for loss ratio information

21. UNF Voluntary Plan • The Death Spiral • Adverse selected resulted in increased loss ratios

22. Florida Student Insurance Consortium • University of South Florida • Florida Gulf Coast University • University of Central Florida • University of North Florida • University of West Florida • Will add Florida International in 2012-2013

23. Consortium • Joined the Florida Consortium-Selected by Insurance Committee • Idea was to get the best rate possible and still provide good, reliable, affordable health insurance for all students by joining with other Florida schools. • 2011-2012 – United Health Care (Gallagher-Koster) • PROS: CONS: • Excellent coverage, low deductibles & copays • To our knowledge, not one claim rejected • Excellent client services, user-friendly web-site • Accurate and thorough monthly reports/meetings • Extensive literature and marketing tools made available to UNF • Domestic Students (Voluntary Plan) $2,714.00/year. (+/$1,419.00 increase) • International Students (Hard Waiver Plan) $1,919.00/year. (+/$624.00 increase) • Increased rates due to high loss ratios from prior two years. • Decrease in domestic student participation – many could not afford premiums.

24. The New ACA Benefits • 2012-2013 – United Health Care (Gallagher-Koster)-Requesting Review by Insurance Committee • Domestic Students (Voluntary Plan) $2,867.00/year (+/$153.00 increase) • International Students (Hard Waiver Plan) $1,924.00/year (+/$5.00 increase) • 5.6% increase for Domestic/ .3% for International due to excellent claims loss ratio for 2011-2012 • Allowing installment payments for the insurance premium • The new Federal Regulations have enhanced coverage in the following areas: • Unlimited Prescription Drug coverage • Unlimited Preventative Health Services • Unlimited Ambulance services • Unlimited Hospice Care Benefits • These mandatory increased benefits prompted a redesign of the current plan to keep premiums affordable. These changes include: • Increase in Deductible to $400/$600 per Policy Year • Increase in Physician’s visit co-pay from $25 to $30 • Increase in Consultant’s visit co-pay from $40 to $45 • Implementation of $30 copay for labs and X-ray visits

26. Florida State University Virginia Steward • History of HealthInsurance at FSU • Prior toFall 2007, insurancecoveragewasvoluntary • Health Center staff and studentleadersworkedtogethertogainsupportfromtheDivision of Student Affairs, UniversityPresident and Board of Trustees (2003 – 2007) • Approval received and effectiveFall 2007 , allnewincoming full-time studentsrequiredtopurchaseorverifyexisting comparable coverageviaan on-line waiverprogram

27. Florida State University Virginia Stewart

28. Florida State University Virginia Stewart • WhytheChange? • Inadequatecoverageforthestudentduetosmallpurchasing pool • Limited pool of insurancecompaniesresulting in a decrease in Student HealthPlansavailable • Escalatingpremiumswithdecreasedbenefits • UnacceptableLoss Ratio • Missiontoassiststudents in theirsuccessthroughimprovedphyical and mental health

29. Florida State University Virginia Stewart • HowWeMadeItWork • ImplementedElectronic Medical Records (EMR) • Reallocated a portion of the Medical Records budgettoestablishtheHealthCompliance Office • Becamean “in-network” providerwithmultipleinsuranceplanstoenablestudentstoreceivemaximumbenefitsfromtheirplans • Databasedesign and implementationincluding self-service, 24 houravailability

30. Florida State University Virginia Stewart • Challenges of GoingMandatory • Initial “push back”=100% aggravation + 0% compensation • Educatingincomingstudents, theirparents and otheruniversitydepartments • Creatingthesystemfor on-line insurancepurchases and waiversalongwithenhancinginsurancebillingfunctions • Determiningrequirementsfor comparable insurance • In-patient and out-patientcoverage • Mental Healthcoverage • PrescriptionCoverage • Network Providers in FSU region • MaternityCoverage • Minimumpolicylimits

31. Florida State University Virginia Stewart • OngoingChallenges • Verification of healthinsurancecoverage • Tracking student status changes • Student errors in thewaiver and purchasesystem • Inconsistencyamonginsuranceplansregardingmaternitycoverage • Studentsunder age19 cannotpurchasean individual plan • HMO plansoften do notprovide “awayfrom home” care • Enteringtheinsurancecontracting and complianceworld

32. Florida State University Virginia Stewart • AdvantagesRealized(continued) • AccidentialDeath & Disabilitybenefit • Student participationontheInsuranceCommittee • Studentshave a forumtovoicetheirconcerns • Studentsprovide input in selectingpolicybenefits • Aids in continuedstudentsupportformandatoryhealthinsurance • Educatesstudentsfortheirfuture in thehealthcaresystem • Students do notleavecollegewith medical debt in additiontotheireducationaldebt

33. Florida State University Virginia Stewart • AdvantagesRealized • Thecurrent Student HealthInsurance Plan at FSU alreadymeetstheAffordableHealthcarerequirements • Studentshaverealizedimprovedcoveragewithreducedcost • Earlier diagnosis of seriousconditionsduetodecreasedfinancialpressures • Clinicians can treatthestudentwithoutthefinancialpressuresthataccompanytheuninsuredstudent

34. Student Health Insurance • Who is on First • What is on second • I don’t Know’s on Third