Presentation on theme: "North Carolina Consortium 2012- 2013 Renewal Rates April 16, 2012."— Presentation transcript:
North Carolina Consortium 2012- 2013 Renewal Rates April 16, 2012
2 2012-13 Plan Guidelines Withdrawal from School and Premium Refunds If a student is: a) enrolled on a UNC campus, and b) enrolled in the student health insurance plan, then the following refund rules apply: If a student totally withdraws from school before the xxth day of classes in the semester, then a paid insurance premium will be refunded and any claims paid will be recouped. If a student totally withdraws from school due to a university documented medical withdrawal before the xxth of classes, then an exception to this refund policy may be made once during the student’s UNC career by the student submitting an appeal for refund to Pearce & Pearce. If a student totally withdraws from classes on or after the xxth day of classes in the semester and has not filed any claims as of the date of withdrawal, then the student has 10 business days to request a full refund of the premium. In the absence of such a request, the premium will not be refunded. If a student totally withdraws from classes on or after the xxth day of classes in the semester and has filed a claim(s) as of the date of withdrawal, then no premium will be refunded. Rx Benefits and Enhancements All specialty drugs will go through Ascend, Informed Rx. A new Rx formulary will be developed based upon suggestions made by the Rx Formulary Workgroup. Graduate Student Threshold for Plan Eligibility A campus currently with a 1 credit hour eligibility threshold for graduate students may change to a threshold of 2-6 credit hours for 2012-13. However, no campus currently at a 6 credit hours threshold can drop to a lower threshold.
3 Benefits Comparison: 2012-13 vs. 2011-12 Medical Maximum: $100,000 per sickness or per injury per policy year with 80% in-network / 70% out-of-network coinsurance; this benefit exceeds PPACA regulations 2011-12: same Rx Benefit Maximum: as per PPACA, $100,000 policy maximum with $10 co-pay at SHC; outside pharmacy co-pay is $25 / $50 / $100 based on a 3-tier formulary and then covers 80% after co-pay 2011-12: $1,000 maximum with $10 co-pay at SHC; outside pharmacy was $10 / $25 and then covered 80% after co-pay Birth Control: as per PPACA, $100,000 policy maximum with 100% coverage at SHC; outside pharmacy co-pay is $25 / $50 / $100 based on a 3-tier formulary and then covers 80% after co-pay 2011-12: was within the $1,000 Rx maximum; $10 co-pay at SHC; outside pharmacy co-pay was $10 / $25 and then covered 80% after co-pay Preventive Care Maximum: as per PPACA, up to $100,000 policy maximum with 100% coverage at SHC; $300 annual policy deductible will apply if outside SHC 2011-12: wellness was an enhancement and preventive care immunizations were limited to $500
4 Benefits Comparison: 2012-13 vs. 2011-12 (continued) Anesthesia Benefit: 80% in-network / 70% out-of-network 2011-12: anesthesia paid at 25% of surgeon’s fee Out-of-Pocket: maximum of $4,000 in-network / $8,000 out-of-network 2011-12: $2,000 in-network / $4,000 out-of-network Office Visit Co-pay: $0 office visit co-pay at SHC; $20 office co-pay outside SHC 2011-12: $0 office co-pay at SHC; $10 office co-pay outside SHC ER Visit Co-pay: $300, waived if admitted 2011-12: $150, waived if admitted Urgent Care Co-pay: $75 with 80% in-network / 70% out-of-network coinsurance; co-pay waived if referred to ER and only the ER co-pay would then apply 2011-12: $0 co-pay and paid at 80% in-network / 70% out-of-network Intercollegiate Sports Limited Benefit: $3,000 2011-12: $3,000 Limit All other base plan benefits remain the same
Rate Options (excludes $10 per semester that remains with the campus to support administration of the student health insurance plans) Composite Rate (all campuses must choose this option for it to be in effect) Age Banding Rates (an individual campus may choose this option) Undergraduate / Graduate Rates (an individual campus may choose this option)
1.UNC may only use the COMPOSITE RATE ($1,398 per year; $699 per semester; $116.50 per month) if all sixteen campuses use this pricing model, OR 2.Each UNC campus may select on a campus by campus basis either: a)the AGE BANDING RATE; a student’s age is based on the student’s age as of August 1, 2012 and will be applied to the 2012-13 policy year <25$1,008 per year; $ 504 per semester; $ 84.00 per month 25-34$2,016 per year; $1,008 per semester; $168.00 per month 35-44$3,314 per year; $1,657 per semester; $276.17 per month >44$3,970 per year; $1,985 per semester; $330.83 per month OR b)the UNDERGRADUATE RATE ($1,228 per year; $614 per semester; $102.33 per month) and GRADUATE RATE ($2,180 per year; $1,090 per semester; $181.67 per month); the student’s enrollment status of undergraduate vs. graduate is based on the student’s enrollment status at the beginning of the semester Pricing Options Summary (premiums are paid by semester )
7 Enhancements *No school may purchase a lower deductible than their current deductible in 2011/2012. **These enhancements can only be purchased by a school that selected them for 2011-2012