Ann McMican MS Assoc. Director, UHS, University of RochesterDoreen Perez MS RN BC Director of SHS UNFVirginia Stewart BA Manager Health Compliance FSU

ACHA Chicago 2012

• www.youtube.com/watch?v=sShMA85pv8M

• 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.

• 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

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

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

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.

Customer Focus - ACHA standards for student health insurance were met in all but one category

•The UR plan did not provide prescription coverage

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

Customer Focus - E-Survey Results

If prescription coverage were added, what’s the largest acceptable premium increase?

Grad Undergrad ParentI 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%

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%

Customer Focus - E-Survey Results

My annual prescription costs are:

Grad Undergrad Parent0 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%

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

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.

• History of insurance at UNF• The Lean years• The Abundant years• The Death Spiral• The Building of a Consortium• The New ACA Benefits

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

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

• 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

• The Death Spiral• Adverse selected resulted in increased loss ratios

COMPANY YEAR PREMIUM CLAIMS LOSS RATIO ANNUAL RATE NOTES                         BCS INS. CO 2003/04 $276,664 $237,863 86% $698        BCS INS. CO 2004/05 $282,790 $236,368 84% $733        BCS INS. CO 2005/06 $296,089 $204,824 69% $818        BCS INS. CO 2006/07 $238,636 $170,040 71% $883        

BCBS 2007/08 $498,929 $349,002 70% $876 *INCLUDED ATHLETES      

BCBS 2008/09 $630,277 $612,533 100% $976        

BCBS 2009/10 $784,958 $1,214,1

11 141% $1,105        BOLLINGER 2010/11 $744,413     $1,295        

• 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

• 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.•

• 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

•  

I. History of Health Insurance at FSU

• Prior to Fall 2007, insurance coverage was voluntary

• Health Center staff and student leaders worked together to gain support from the Division of Student Affairs, University President and Board of Trustees (2003 – 2007)

• Approval received and effective Fall 2007 , all new incoming full-time students required to purchase or verify existing comparable coverage via an on-line waiver program

II. Why the Change?

• Inadequate coverage for the student due to small purchasing pool

• Limited pool of insurance companies resulting in a decrease in Student Health Plans available

• Escalating premiums with decreased benefits

• Unacceptable Loss Ratio

• Mission to assist students in their success through improved phyical and mental health

IV.How We Made It Work

• Implemented Electronic Medical Records (EMR)

• Reallocated a portion of the Medical Records budget to establish the Health Compliance Office

• Became an “in-network” provider with multiple insurance plans to enable students to receive maximum benefits from their plans

• Database design and implementation including self-service, 24 hour availability

III. Challenges of Going Mandatory

• Initial “push back”=100% aggravation + 0% compensation

• Educating incoming students, their parents and other university departments

• Creating the system for on-line insurance purchases and waivers along with enhancing insurance billing functions

• Determining requirements for comparable insurance• In-patient and out-patient coverage• Mental Health coverage • Prescription Coverage• Network Providers in FSU region• Maternity Coverage• Minimum policy limits

V. Ongoing Challenges

• Verification of health insurance coverage• Tracking student status changes• Student errors in the waiver and purchase system• Inconsistency among insurance plans regarding

maternity coverage• Students under age19 cannot purchase an individual

plan• HMO plans often do not provide “away from home”

care• Entering the insurance contracting and compliance

world

VI.Advantages Realized (continued)

• Accidential Death & Disability benefit

• Student participation on the Insurance Committee• Students have a forum to voice their concerns• Students provide input in selecting policy benefits• Aids in continued student support for mandatory health insurance• Educates students for their future in the health care system

• Students do not leave college with medical debt in addition to their educational debt

VI.Advantages Realized

• The current Student Health Insurance Plan at FSU already meets the Affordable Healthcare requirements

• Students have realized improved coverage with reduced cost

• Earlier diagnosis of serious conditions due to decreased financial pressures

• Clinicians can treat the student without the financial pressures that accompany the uninsured student

• Who is on First

• What is on second

• I don’t Know’s on Third