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Presentation on theme: "MAY 16, 2013 LORI VIVIAN, HUMAN RESOURCES MIKE KURLAND, STUDENT HEALTH SERVICES 2013-14 Graduate Assistant Plan Changes."— Presentation transcript:


2 Background GAs eligible for State Employees Health Plan until fall 2003 State officials determined that GAs were ineligible for Employee Plan UConn considered including GAs in the Student Insurance Plan, but elected not to Student Insurance Plan had much lesser benefits State signed an MOU with the University to provide a Graduate Assistant Plan Graduate Assistants Graduate Fellows Students at UCHC State manages GA Plan, with no UConn involvement Develop the annual contributions Determine benefit modifications Solicit bids Select vendors

3 GA Issues with Current Plan Confusion regarding Student Health Insurance and GA insurance GAs often waive student insurance in Student Administration System and assume it is for GA insurance GAs will often receive Aetna student insurance card in the mail (if GA paperwork is processed late); once the card is used, the GA cannot waive the student insurance Network providers only in CT, out-of-network coverage subject to high deductible ($1,000) Non compliant with international student requirements, requires additional insurance Effective date after start of semester, requires gap insurance Open enrollment held in May with June deadline, when many GAs are away from school

4 Financial Concerns State changed funding arrangement to self-insured effective September 1, 2010 Claims/premiums could not be comingled with Employee Plan If claims exceed premium, UConn must pay the carrier the excess claims Unlimited Risk No individual or aggregate stop loss insurance First accounting on claims experience from the State produced in September 2012 State recommended a retroactive premium increase: Medical: 24.5% ($1.7 million), Dental: 8.6% ($200,000) UConns deficit for period 9/01/10 – 8/31/2012: $2.3 million Significant increase in UConn premium cost $4.9 million (2010-11) to $7.9 million (2013-14)

5 Administrative Challenges States system (CORE-CT) is not designed to handle academic calendar Each enrollment/termination requires individual processing No opportunity for mass processing the 500+ that occur each August No opportunity for data transfer between Student Administration System Nearly every GA enrollment requires retro processing by Payroll Only those paid by the State can be in CORE-CT GA Fellows are administered outside the system UConn GAs are not paid over the summer Premiums collected in advance (18 paychecks versus 26 paychecks), which requires special processing by the State, Payroll, and insurance carriers System is available for open enrollment only once each year (May/June) State Response to Issues Focus is on State Employee Health Plan, no resources available to address GA issues

6 Student Insurance Change History 2007-2008 Plan design had MANY inside maximums and variations (dated plan design) Coverage was limited. Hard to administer and understand for a consumer 2008-2009 Implemented a $50,000 Policy Year Maximum (across the board) $250 In Network / $500 Out of Network Policy Year Deductible (waived at SHS) Labwork not subject to the Policy Year deductibles Referrals required for Storrs students only 90% coverage for In Network claims; 70% for Out of Network Office Visits: $25 copay when In Network; 70% Out of Network Implemented a $5,000 Outpatient Maximum (including Surgeries Implemented a $1,000 RX maximum per policy year with copays of $15/$30 Cover Anesthetist at 90/70 benefit levels Emergency Care Expenses covered at 90/90 benefit levels after a $50 deductible Cover STD screenings Continue to Exclude Annual Physicals, Annual Eye Exams, and coverage for Titers

7 Student Insurance Change History 2009-2010 Implemented a $150 ER Copay Implemented the Hard Waiver Audit Implemented a $100,000 Plan Maximum Removed the Pre-Existing Condition Clause Added coverage for SHS Office Visits Sports Coverage: $2,000 Benefit Under the Medical Plan (paid for by Athletics) 2010-2011 Removed inside Plan Maximum of $5,000 ( surgical, MH etc.) Removed the exclusion for sexual reassignment surgery 2011-2012 Increased Plan Maximum to Unlimited Coverage Increased RX Maximum to Unlimited Coverage Preventative Services covered at 100%(including physical exams, immunizations, etc.) Implemented a $5,000 Out of Pocket Plan Maximum

8 Student Insurance Change History 2012-13 (Affordable Health Care Act) Removed all internal plan maximum amounts and further prospective compliance with Affordable Care Act, including 100% coverage for outpatient contraceptive drugs and device expenses 2013-14 Continued compliance with new Affordable Health Care Act regulations

9 Bid Process Agreement was reached to include GAs in the Student Health Insurance bid process Originally scheduled for 2012-13 year Delayed one year because State information regarding GA experience was unavailable Further delayed because GA claim data was incomplete Expedited bid process Quotes solicited in December Bids received in January Selection committee selected winning vendor in February Presentations to senior management, Grad School, GSS Executive Committee Presented to Board of Trustees at next available meeting (April 24) Winning Bidder Consolidated Health Plan (CHP), utilizing CIGNA network of providers Broker: Bailey Agencies

10 GA vs. Student Insurance Comparison Key FeaturesGA PlanStudent Plan (2013-14) Network - CarrierAnthem Blue Cross Blue ShieldCIGNA - Service area of network providersCT onlyNationwide - Number of providers15,000 – 16,000700,000 - Out of network coverageAvailable to GAs for additional costIncluded Healthcare Services - Network Provided - Office visit copays$10 primary care, $20 specialists, $35 urgent care $0 students seen at SHS, $0 adult physical exams, $25 all other - Hospital$250 copay, then 100% paid by plan 90% paid by plan, 100% paid by plan after students 10% reaches $5,000 - Emergency room100% paid by plan100% paid by plan if admitted, $150 copay if not admitted - Outpatient surgery100% paid by plan90% paid by plan - Laboratory100% paid by plan90% paid by plan - X-rays100% paid by plan90% paid by plan - Annual deductibleNone$250 (waived if student seen by SHS) Healthcare Services When Using Providers Who Are Not In Network Available only if purchased: 70% paid by plan after GA pays $1,000 annual deductible, 100% paid by plan when GAs 30% reaches $3,000 70% paid by plan after student pays $500 annual deductible, 100% paid by plan when students 30% reaches $5,000 Prescriptions $10 generic $20 preferred brand $30 non-preferred brand $15 generic $30 brand name Medical Evacuation and RepatriationNoneIncluded Effective Date of CoverageSeptember 1 (Note: GAs required to have coverage while at school, students without coverage must purchase short-term medical policy) August 15

11 Annual Cost of New Plan Paid by GA Paid by UConn Total GA Only $ 200$ 3,730$ 3,930 GA + 1 $1,440$ 8,160$ 9,600 Family$1,822$10,328$12,150

12 Advantages Achieved Economies of scale Enrolled Students: 2400, Enrolled GAs: 1800 Fully insured Liability is limited to premiums Ability to budget Ability to modify plan UConn selects plan design and carriers UConn puts the plan out to bid Simplified Administration Limited in first year, but anticipate significant changes for next year Cost savings Difficult to estimate, but anticipated at approximately $1million

13 Next Steps Finalize details of the plan design Determine the premium collection process Develop enrollment process Continuing GAs Incoming/new GAs Communicate, communicate, communicate

14 Questions

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