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University Health Plans, Inc.

University Health Plans, Inc. Student Health Insurance Plan Presented to:. UNIVERSITY HEALTH PLANS. UHP’s Success 20+ years experience Pioneered web-based enrollment/waiver system 100% Student Health Programs 60 College and University Clients Accountable Management/Decision Making.

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University Health Plans, Inc.

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  1. University Health Plans, Inc. Student Health Insurance Plan Presented to:

  2. UNIVERSITY HEALTH PLANS • UHP’s Success • 20+ years experience • Pioneered web-based enrollment/waiver system • 100% Student Health Programs • 60 College and University Clients • Accountable Management/Decision Making

  3. UNIVERSITY HEALTH PLANS • UHP’s Client Services • Represent the Client • Competitive Premiums • Enrollment/Waiver Billing

  4. UNIVERSITY HEALTH PLANS • UHP’s Client Services(continued) • Customer Service • Student/Client Advocate • Secure Website • Toll Free Number • On-Site Training Available

  5. UNIVERSITY HEALTH PLANS • UHP’s Client Services (continued) • Quarterly reviews/discussions • Plan Evaluation/Plan Design • Claim Reports • - detailed claims analysis • - claim run-out • - prescription drug detail

  6. UNIVERSITY HEALTH PLANS • UHP Client Services (continued) • UHP claims audits • UHP is the student/client advocate • UHP’s complimentary products • State Reports

  7. UNIVERSITY HEALTH PLANS www.universityhealthplans.com • Customized On-Line Services • UHP has developed several on-line resources to meet the needs of each school: • Brochures and other forms on-line or downloadable • On-Line Waiver and Enrollment • On-Line Eligibility look-up • On-Line Claims Status look-up • On-Line ID Card request • Preferred Provider and Member Pharmacy look-up

  8. BCBSMA Promise To Always Put Our Members’ Health First

  9. Our Mission…Our Philosophy • Blue Cross Blue Shield: • Social Contract • Long-term cost & quality focus • 1% - 2% contribution to reserves • Views healthcare delivery and administration as local with a national reach (one size does not fit all) Your long-term partner should have a long-term vision

  10. World Class Performance...Sustained Excellence • Membership & Growth Year end 12/31/06 • Total Members 3,050,000 • New members 128,800 • Dominant market share 40% • Service Excellence • Year end 12/31/06 • Strong Member Satisfaction 85% • Strong Provider Satisfaction 88% • Account Retention 95.8% • Financial Stability • Year end 12/31/06 • Earned Premiums $6.81B • Cash & Investments $2.6B • After Tax Net Income $122M • Statutory Reserves $1.6B

  11. Why Choose Blue?

  12. #1 market share in all 50 states Most recognized brand inhealthcare among consumers #1 in delivering the lowest overall costs (Fortune Magazine, Sept. 2005) 75% of Fortune 100 companies (9 of the top 10) 94 Million covered lives (1 in 3 Americans) Brand Strength The Blues are the Brand leaders among employers and consumers Unaided Brand Awareness 71% Source: Brand Strength Measure Survey (2005)

  13. Network Access and Discounts

  14. The Blue Cross Blue Shield Network Advantage • Local Networks • Over 15,000 providers* • 85 hospitals • Stable mature networks (consistent local benefit delivery) • Regional Networks • Over 32,000 providers* • 181 hospitals throughout New England • Stable mature networks (consistent regional benefit delivery) • National Networks • Over 1,000,000 providers* • Over 6,000 hospitals • Stable, mature networks (consistent national benefit delivery) • Only nationwide network with secondary and rural locations Benefit to Bentley College More claims processed in-network provides savings; unsurpassed access to care allows consolidation ease *Includes Adult PCPs, Pediatricians, Ob/Gyns, Specialists

  15. The Blue Cross Blue Shield Network Advantage (cont.) • Assessing network value: • Low unit cost (per claim discounts) • Care Management (utilization controls) • Depth & Breadth of networks (access to care) Blue Cross Blue Shield is the recognized industry leader in network value

  16. Healthy Member Interventions • Prevention and wellness communications and programs • Healthy Blue Programs • Worksite Wellness Programs • Comprehensive e-health and communication strategies to address a large population with non-complex health issues • www.ahealthyme.com • www.bluecrossma.com Award Winning Web Sites

  17. Support: LIVING HEALTHY Babies Living Healthy Smoke-Free Blue Care Line – 24/7; (888) 247-BLUE DecisionCare Guide Campus Wellness Healthy Blue at School Personal Edge (fee for service) Incentives: Fitness Benefit - $150 per yr. Weight Loss Benefit - $150 per yr. Discounts (bike helmets, safety products) Living Healthy Naturally: 20% discount on acupuncture, massage therapy, nutrition counseling Living Healthy Vision: Up to 25% discount (frames, lenses, contacts) Healthy Blue Programs

  18. Care Management • Program Goals • improve health status, quality of life, lower rates of complication and inpatient admissions • Member Identification • claims data, PHRAs, episodes of care, physician referral, member referral • Specialized Programs • transplants • outpatient therapies • pediatric focus • rare diseases – multiple sclerosis, cystic fibrosis, Parkinson's

  19. Old Thinking: Quality is a given. So, contain costs. Gaps in care Unsustainable rise in costs Think once, Order twice Pay for metrics (HEDIS based) New Thinking: Promote quality and costs will be contained. Fewer adverse events Reduced waste Think twice, order once Pay for performance (evidence based) Blue Cross Blue Shield’s View of the Future… © 2006 Blue Cross Blue Shield Association. All Rights Reserved.

  20. Claims Processing • Average turnaround time – 3.6 days (year end 2006) • Auto adjudication rate – 91.2% (year end 2006) • Claim payment accuracy – 99.7% (year end 2006) • Financial accuracy – 99.9% (year end 2006)

  21. BCBSMA Student Business • History • Harvard University • Massachusetts Institute of Technology • Northeastern University • UMass Dartmouth • UMass Worcester • Berklee College of Music • Underwriting Rationale

  22. Bentley College Student Plans • PPO Benefit Plan • Referrals not required • 100% in-network nationally • 80% out-of-network nationally

  23. PPO Benefits (option 1 – 100/80) BenefitIn-NetworkOut-of-Network Maximum Unlimited Unlimited Deductible None $250 per member Office Visits $15 Co-Pay then 100% 20%* Emergency Room $50 Co-Pay then 100% $50 Co-Pay the 100% Maternity Care (inpatient) No charge 20%* Vision Exam Co-Pay then 100% 20%* (1 per 24 mos.) Prescription Drugs (ESI) $10/$25/$45Co-Pay ** Not Covered *Deductible applies **No annual maximum Option 1 = $984.00 annual student rate (add $5.00 for on-call travel assist and $3.00 for $10,000 AD&D coverage)

  24. PPO Benefits (option 2 – 90/70) BenefitIn-NetworkOut-of-Network Maximum Unlimited Unlimited Deductible $250 per member*** $250 per member*** Office Visits $15 Co-Pay then 100% 20%* Emergency Room $100 Co-Pay then 100% $100 Co-Pay then 100% Maternity Care (inpatient) 10%* 30%* Vision Exam $15 Co-Pay then 100% 20%* (1 per 24 mos.) Prescription Drugs (ESI) $10/$25?$45 Co-Pay ** Not Covered *Deductible applies **No annual maximum ***In and out-of-network combined Option 1 = $891.00 annual student rate (add $5.00 for on-call travel assist and $3.00 for $10,000 AD&D coverage)

  25. PPO Benefits (option 3 – 80/60) BenefitIn-NetworkOut-of-Network Maximum Unlimited Unlimited Deductible $250 per member*** $250 per member*** Office Visits $20 Co-Pay then 100% 20%* Emergency Room $100 Co-Pay then 100% $100 Co-Pay then 100% Maternity Care (inpatient) 20%* 40%* Vision Exam $20 Co-Pay then 100% 20%* (1 per 24 mos.) Prescription Drugs (ESI) $10/$25/$45 Co-Pay ** Not Covered *Deductible applies **No annual maximum ***In and out-of-network combined Option 1 = $802.00 annual student rate (add $5.00 for on-call travel assist and $3.00 for $10,000 AD&D coverage)

  26. Blue Cross Blue Shield Member Services

  27. Why Choose Blue? • Brand strength and value • Network access and discounts • Innovative products and health care solutions • World class concierge service Uniquely positioned to be Bentley College’s long-term partner

  28. Nationwide Life Insurance Company

  29. Nationwide Life Insurance Company • Nationwide Facts: • Rated A+ by A.M. Best • Insuring student plans for over 6 years • $100 Million in student insurance premium • $30 Million in UHP/Nationwide premium • Access PPO’s for best possible discounts, including • Multi-Plan/PHCS and FirstHealth (HCVM, CCN) • ExpressScripts Rx Plan

  30. Consolidated Health Plans (CHP) Claims Administration Services • CHP Facts: • Headquartered in Springfield, MA • Providing claims payments services for over 10 years • Over 100 College and University clients • $40 Million in paid claims • Flexible Benefits

  31. Consolidated Health Plans (CHP) Claims Administration Services • CHP Claims Payment Statistics: • Average turn around time 5-7 business days on “clean” claims • Payment at 99% accuracy • Random audits performed to ensure consistent accuracy • Utilization review on claims over $10,000

  32. Consolidated Health Plans (CHP) Claims Administration Services • CHP Customer Service Statistics: • Same day response for calls received before 2:00 pm • 24 hour response time for all email inquiries • Continual customer service training to ensure accuracy of responses

  33. Consolidated Health Plans (CHP) Claims Administration Services • CHP On-Line Services: • Available 24/7 • Eligibility status look-up • Claims status inquiry • On-Line “EOB”, including date of service, payment date, PPO savings, patient responsibility, etc. • Preferred provider look-up • On-line/printable brochure

  34. Member Services

  35. Nationwide Life Insurance Company Option 1 2nd Year Cap of no more than 14%

  36. Nationwide Life Insurance Company Option 2 2nd Year Cap of no more than 14%

  37. Nationwide Life Insurance Company Option 3 2nd Year Cap of no more than 14%

  38. Nationwide Life Insurance Company Benefit Modifications

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