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Health Insurance after UC SHIP Individual Health Insurance in California and Other Options. University of California Student Health Insurance Plan (UC SHIP) Office of the President, Risk Services 2012-2013. Insurance Options After UC SHIP. Are You Under Age 26?

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health insurance after uc ship individual health insurance in california and other options

Health Insuranceafter UC SHIPIndividual Health Insurance in California and Other Options

University of California

Student Health Insurance Plan (UC SHIP)

Office of the President, Risk Services

2012-2013

insurance options after uc ship
Insurance Options After UC SHIP

Are You Under Age 26?

If you have dual coverage with UC SHIP and your parents’ employer health plan, Health Care Reform law allows you to stay on your parents’ plan until your 26th birthday.

If you dropped your parents’ health plan when you started UC SHIP, Health Care Reform law allows you to re-enroll and remain on your parents’ health plan until your 26th birthday.

You may be asked to provide proof of loss of coverage under UC SHIP to re-enroll. Request a Certificate of Creditable Coverage From Anthem Blue Cross Customer Service—(866) 940-8306

slide3

Insurance Options After UC SHIP—Summarized

  • UC SHIP Voluntary Continuation Plan—A one-term extension
  • Private “Individual” Health Insurance

HMO, PPO, & High Deductible Plans

      • Alumni Association Insurance Program
      • Individual Health Insurance Plans
      • Short-Term Individual Health Insurance Plans
      • Anthem Blue Cross Conversion Plan (UC SHIP members only)
  • Public Health Care Programs

Medi-Cal Programs & Access for Infants and Mothers (AIM)

find the right plan assess your health care needs
Find the Right Plan: Assess your health care needs

Questions to ask yourself before you purchase insurance:

Do you have a pre-existing health condition?

A pre-existing condition is a medical condition diagnosed or treated within 6 months prior to your application for Individual health insurance, including pregnancy.

If yes, you may not qualify for an “individual” insurance plan

What is your residency status?

Are you leaving California? You must be CA resident to enroll in California individual insurance plans

What are your health care needs?

For example, do you have a spouse or children?

slide5

Find the Right Plan: Assess your health care needs

  • More Questions to ask yourself:
  • Are you starting a job soon?
  • Will you have health benefits? / When will benefits begin?
  • Can you be covered by your parent’s plan?
  • If you are under age 26, you may be eligible to join or stay on their plan
  • What is your income level?
  • Are public health care programs available to you?
glossary of key health insurance terms
Glossary of Key Health Insurance Terms
  • HMO (Health Maintenance Organization)

A plan in which you choose a primary care physician (PCP) who coordinates care with providers in the plan network—no coverage outside network

  • PPO (Preferred Provider Organization)

A plan in which you have direct access to providers in the plan network, as well as non-network providers at higher cost to you

    • Network or “Participating” Providers: Providers (individuals and facilities) accept a negotiated or contracted rate as full payment for services—no “balance billing”
    • UC SHIP is a PPO Plan (Anthem’s Prudent Buyer Network) but is unique because it requires students to obtain a written referral prior to receiving services outside of student health services
  • High Deductible Plan

Annual deductible is higher than usual ($1500 or higher) and must be paid before plan benefits are paid.

glossary of key health insurance terms1
Glossary of Key Health Insurance Terms
  • Maximum Allowed Amount

The maximum amount the carrier will reimburse for a

particular service, sometimes based upon “customary & reasonable (C&R)

  • Out of Pocket Maximum
    • Maximum dollar amount you have to pay out of your own pocket for covered health care services during the plan year.

For example, UC SHIP’s In Network out of pocket maximum is $3,000

  • Lifetime Maximum
    • Any amounts above the “lifetime maximum” are your responsibility
    • UC SHIP’s lifetime maximum is $400,000
how insurance works identify your costs
How Insurance Works—Identify your costs

When you are shopping for insurance, do your homework! Make notes on what you will be required to pay for each of the following:

Premium = $$$

Fee you pay to be enrolled in an insurance plan, usually monthly

Deductible = $$ or $$$

Annual Amount you must pay for services out of pocket first, before the insurer will pay for medical and pharmacy services. Other deductibles may apply

Co-Insurance = %

Percentage share of cost expressed in $ for each service (variable; e.g., 20%), after deductible

Copayment = $

Set-dollar share of cost for each service (variable; e.g., $20); not subject to deductible

Insurance Companypays:

Balance after You meet the deductible and pay co-insurance or copayment (if any), for each service — subject to policy terms (i.e., for covered services)

uc ship voluntary continuation plan uc ship for graduating students
UC SHIP Voluntary Continuation Plan—UC SHIP for graduating students
  • Students enrolled in UC SHIP may continue UC SHIP for one academic term after graduation
  • Same great benefits as UC SHIP! Medical - Counseling - Dental - Vision
  • No pre-existing condition limitations
  • Add or continue dependent plan benefits
  • Enrollment is voluntary; premium is different
  • Campus student health services available; must have a referral (on some campuses)
uc ship continuation plan enrollment
UC SHIP Continuation Plan Enrollment

To Enroll in UC SHIP for one academic term after graduation, contact:

Wells Fargo Insurance Services

  • Phone: (800) 853-5899; FAX (916) 231-0527;
  • Address: 10940 White Rock Road, 2° Floor, Rancho Cordova, CA 95670
  • The full premium must be paid prior to receiving coverage

Note: student health insurance plans are not subject to federal or state COBRA laws, so COBRA is not applicable for UC SHIP members who graduate or leave the University for reasons other than graduation.

alumni association health insurance for graduating students
Alumni Association—Health Insurance for graduating students

Most campus Alumni Associations offer health insurance to graduating students—check it out.

Long-term & short-term plans

Plans that accept enrollees with pre-existing conditions

Discounts are available on some campuses, with a health questionnaire

For most campus Associations, the student must join the Alumni Association to qualify for their insurance program

private individual health insurance plans
Private Individual Health Insurance Plans

Contact California Insurers or research online:

Anthem, www.anthem.ca.com

Kaiser Permanente, www.kp.org

Blue Shield, www.blueshieldca.com

Health Net, www.californiahealthplans.com/healthnet

Aetna, www.aetna.com

Rate Determination: Insurance companies rate individuals by age, residence (zip code), and health status

You must complete a Health Questionnaire and qualify for individual insurance to enroll. This is called:

Underwriting—The review of your medical history to assess the RISK of accepting you for policy coverage

slide13

Private Individual Health Insurance Plans

  • Must be a California Resident
  • Individuals with Pre-existing Conditions are not eligible
  • Short-term policies are available
  • PPO and HMO’s policies are available
  • Cost Choices:
    • High deductible plans = lower premium
    • Full benefit plan vs. limited benefit plan affect cost
      • Some limited benefit plans exclude maternity benefits and provide generic-only prescription drug coverage
    • Out-of-pocket maximum can also be an important cost factor
california short term health plans
California Short Term Health Plans

Coverage is available for 30 days (minimum) up to 185 days

Also known as “gap” insurance: Check it out at ehealthinsurance.com

Can be extended with limitations — not extendable if any claims in policy period

Ineligible if you have a pre-existing condition

Must be a resident of California

Premiums can be lower than standard individual plans

Short health questionnaire —“streamlined” underwriting

Anthem Blue Cross and Health Net offer short-term health plans:

www.hccmis.com/short-term-medical

Caution: If you develop a health condition while on a short-term plan, you may be ineligible later for a standard individual plan

anthem blue cross california conversion plan
Anthem Blue Cross California Conversion Plan

UC SHIP members who leave the University

The California Conversion Clear Protection Plus 5000 plan is an option intended for individuals with serious ongoing health issues. Benefits & Premium vary from UC SHIP.

Eligibility Rules

You must have been covered under UC SHIP for 3 consecutive months prior to applying for Conversion

You must not be receiving health care benefits under UC SHIP or any other group or individual health plan; you must not be eligible for Medicare

You must apply within 63 days of the date your UC SHIP coverage ends.

To access the California Conversion Clear Protection Plus 5000 Plan rates, benefit summary, and application go to ucop.edu/ucship; click on your campus name; then click on Online Medical Services to find the Conversion Plan link. Or call (800) 333-0912.

major risk medical insurance program mrmip
Major Risk Medical Insurance Program(MRMIP)

Government program administered by the Managed Risk Medical Insurance Board (MRMIB) for low-income individuals

Comprehensive medical benefits: physician & hospital services; $500 annual medical deductible

Annual benefit limit of $75,000,

Lifetime limit of $750,000

Must be unable to secure adequate coverage in last 12 months — usually, because student was denied individual coverage by an insurer because of a pre-existing condition

Cannot be eligible for Medicare, COBRA or Cal-COBRA

Must bea resident of California

Participating MRMIP health plans in the Bay Area: Anthem Blue Cross, Kaiser, and Contra Costa Health Plan

NOTE: MRMIP PPO plans may have a 3-MONTH WAITING PERIOD FOR PRE-EXISITNG CONDITIONS

pre existing condition insurance plan pcip
Pre-Existing Condition Insurance Plan (PCIP)
  • Government program administered by the Managed Risk Medical Insurance Board (MRMIB) – www.pcip.ca.gov
  • PCIP is mandated by Health Care Reform and is an expansion of MRMIP; medical coverage for individuals with a pre-existing condition are covered under both programs.
      • Comprehensive medical benefits for inpatient/outpatient physician & hospital services; annual deductible $1,500 in-Network & $500 brand-name prescription drug deductible

Must have had no health insurance coverage for past 6 months

(a student just leaving UC SHIP would not qualify) No dependent enrollment.

      • Must have been denied individual insurance coverage within last 12 months for a pre-existing condition
      • Cannot be eligible for Medicare, COBRA, or CalCOBRA
      • Must bea resident of California, and a US citizen, US National or qualified immigrant
public health insurance programs for low income
Public Health Insurance Programs for low-income

Medi-Cal for Families

Families (adults and children) who are eligible through the CalWORKS program, or a single adult solely responsible for child/children

Pregnancy-related Programs: Medi-Cal and Access for Infants and Mothers (AIM)

Services are provided to women who are under or uninsured — regardless of immigration status. This is short-term coverage; until 60 days after childbirth

Aid-related Programs

Individuals who receive cash aid through certain federal government programs are automatically entitled to Medi-Cal, including CalWORKS and Supplemental Security Income (SSI)

For all Medi-Cal programs, certain financial eligibility criteria apply, and the individual or family may have

a cost-share requirement

be an informed consumer
Be an Informed Consumer!
  • Health Care IS a commodity

Therefore, be an informed consumer:

1. Compare plans and prices

      • Brokers can help
      • Insurance company sales person
      • Internet broker

2. Get multiple quotes before applying

3. Know what you are purchasing

Money —

        • premium, deductible, coinsurance, copayments, out-of-pocket or coinsurance maximum

Services —

        • what’s covered and what’s not
        • how are services reimbursed (what’s your responsibility?)

Exclusions —

        • e.g., pre-existing conditions, maternity, prescription drugs

Limitations —

        • e.g., inpatient and outpatient behavioral health services
slide20

How to Get Started—To summarize….

  • If you are declined coverage, what are your other insurance options?
      • Stay in UC SHIP for one additional term if you are eligible—no pre-existing condition limitations
    • Alumni Assn’s Insurance Program with “guaranteed acceptance” option for new grads (must meet certain requirements)
    • Anthem Blue Cross Conversion Plan (for UC SHIP members only)
    • Pre-Existing Condition Insurance Plan (PCIP) or Major Risk Medical Insurance Program (MRMIP)
    • If you are pregnant and low-income, you may qualify for Medi-Cal or Access for Infants and Mothers (AIM)
slide21
How to Get StartedYou can request a Certificate of Creditable Coverage From Anthem Blue Cross Customer Service—(866) 940-8306!
  • Know your Deadlines
      • Applications for individual health insurance can be submitted 30 days prior to loss of UC SHIP coverage
  • Enrollment turn-around times
      • Short-term insurance plan (30 to 185 days) enrollment approval turn-around time is generally 1-3 days
      • Individual insurance enrollment approval minimum turn-around time is 10 to 14 business days (can be longer)
  • Anthem Blue Cross Conversion Plan
      • MUST enroll within 63 days of losing UC SHIP coverage
health insurance private insurers
Health Insurance — Private Insurers

Anthem Blue Cross of California — Private health plans, Medi-Cal, AIM & MRMIP: www.anthem.com/ca or (800) 777-6000

Blue Shield of California — Private health plans: www.blueshieldca.com or call (800) 660-3007

Health Net — Private health plans: www.healthnet.com or call (800) 909-3447

Kaiser Foundation Health Plan — Private health plans & MRMIP: www.kaiserpermanente.org/individuals or call (800) 232-5100

health insurance county public agencies
Health Insurance — County Public Agencies

Contact county social services in the area where you reside.

  • Managed Risk Medical Insurance Board (MRMIB) —
      • PCIP: http://www.pcip.ca.gov/pcip_program/default.aspx or call (877) 428-5060
  • MRMIP: http://www.mrmib.ca.gov/mrmib /MRMIP.shtml or call (800) 289-6574
health care insurance resources
Health Care & Insurance Resources

Barney & Barney LLC (formerly Saylor & Hill)

http://www.barneyandbarney.com/individual-family-students/

Janie Williams at Barney & Barney (888) 334-7259 —

Licensed insurance broker for

Anthem Blue Cross,

Blue Shield of California,

Health Net,

Kaiser,

Aetna

eHealthInsurance — Licensed online health insurance broker www.ehealthinsurance.com

acknowledgements and credits
Acknowledgements and Credits

California HealthCare Foundation:www.chcf.org

Kaiser Family Foundation:research and communications about health care and health policy www.kff.org

HealthCare.Gov:official government site provides information on finding insurance options, comparing care quality and understanding the new law www.healthcare.gov

California Office of the Patient Advocate:independent office in state government for HMO members www.opa.ca.gov

California Departments of Health Care Services www.dhcs.ca.gov, Insurancewww.doi.ca.gov, & Managed Health Care www.dmhc.ca.gov

Managed Risk Medical Insurance Board: www.mrmib.ca.gov

Special thanks to the UC Berkeley’s Insurance Office for supplying slides that served as the basis for this presentation.