1. The University of North Carolina 1 Sixteen Institutions with One Hard Waiver Insurance Plan The University of North Carolina System-Wide Hard Waiver Student Health Insurance Plan David Rousmaniere, MBA UNC - Charlotte, drousman@uncc.edu Katrin Wesner, MS UNC - Wilmington, wesnerk@uncw.edu American College Health Association June 4, 2010 The University of North Carolina System-Wide Hard Waiver Student Health Insurance Plan David Rousmaniere, MBA UNC - Charlotte, drousman@uncc.edu Katrin Wesner, MS UNC - Wilmington, wesnerk@uncw.edu American College Health Association June 4, 2010

2. The University of North Carolina 2 UNC System Overview 16 four-year public institutions Total enrollment: 220,000 UNC Board of Governors UNC President UNC General Administration Each of the 16 campuses has: o Chancellor o Board of Trustees 16 four-year public institutions Total enrollment: 220,000 UNC Board of Governors UNC President UNC General Administration Each of the 16 campuses has: o Chancellor o Board of Trustees

3. The University of North Carolina 3 Student Health Insurance Terminology Voluntary Model: There is no requirement for a student to have health insurance through the campus plan or a non-campus plan. A student may choose to participate in the campus plan or not. Hard Waiver Model: A student must have either a creditable coverage non-campus health insurance plan or purchase the campus plan. Terminology Voluntary Model: There is no requirement for a student to have health insurance through the campus plan or a non-campus plan. A student may choose to participate in the campus plan or not. Hard Waiver Model: A student must have either a creditable coverage non-campus health insurance plan or purchase the campus plan.

4. The University of North Carolina 4 UNC Campus-Based Student Health Insurance Hard Waiver Campuses = 11 Elizabeth City State University Fayetteville State University North Carolina A&T State Univ. North Carolina Central Univ. UNC Asheville UNC Charlotte UNC Greensboro UNC Pembroke UNC School of the Arts Western Carolina University Winston-Salem State University Hard Waiver Campuses = 11 Elizabeth City State University Fayetteville State University North Carolina A&T State Univ. North Carolina Central Univ. UNC Asheville UNC Charlotte UNC Greensboro UNC Pembroke UNC School of the Arts Western Carolina University Winston-Salem State University Voluntary Campuses = 5 Appalachian State University East Carolina University North Carolina State University UNC - Chapel Hill UNC Wilmington Voluntary Campuses = 5 Appalachian State University East Carolina University North Carolina State University UNC - Chapel Hill UNC Wilmington

5. The University of North Carolina 5 UNC Campus-Based Student Health Insurance Wide Variation Across UNC Campuses There is a wide range of student health insurance coverage, co-pays, and benefits; base benefits vary from $6,000 to $250,000 (2008-09). There is a wide range of premiums; from $396 to $1,565 (2008-09). * the SHI discussion began in Fall 2008 Wide Variation Across UNC Campuses There is a wide range of student health insurance coverage, co-pays, and benefits; base benefits vary from $6,000 to $250,000 (2008-09). There is a wide range of premiums; from $396 to $1,565 (2008-09). * the SHI discussion began in Fall 2008

6. The University of North Carolina 6 Who Designed the SHI Plan? Designing a Quality Plan for All Students Extensive discussions with: o Student Health Center Directors o Vice Chancellors for Student Affairs o NC Department of Insurance o NC Association of Independent Agents o UNC General Administration o UNC Association of Student Governments Designing a Quality Plan for All Students Extensive discussions with: o Student Health Center Directors o Vice Chancellors for Student Affairs o NC Department of Insurance o NC Association of Independent Agents o UNC General Administration o UNC Association of Student Governments

7. The University of North Carolina 7 UNC Board of Governors Review Spring 2009 March 2009: decision made to ask UNC Board of Governors for hard waiver policy approval and not move forward in Fall 2009 May 7, 2009: 3 Health Directors and President/CEO of NCIOM spoke to the UNC Board of Governors about SHI Spring 2009 March 2009: decision made to ask UNC Board of Governors for hard waiver policy approval and not move forward in Fall 2009 May 7, 2009: 3 Health Directors and President/CEO of NCIOM spoke to the UNC Board of Governors about SHI

8. The University of North Carolina 8 UNC Board of Governors Review Summer / Fall 2009 Review feedback from BOG policy discussion on May 7, 2009 Summer 2009: answer BOG questions from May presentations Plan for August 2009 BOG presentation and a BOG vote on a hard waiver model with implementation in Fall 2010 Summer / Fall 2009 Review feedback from BOG policy discussion on May 7, 2009 Summer 2009: answer BOG questions from May presentations Plan for August 2009 BOG presentation and a BOG vote on a hard waiver model with implementation in Fall 2010

9. The University of North Carolina 9 UNC System-Wide Student Health Insurance The Question Presented to the UNC BOG Can better rates and coverage be obtained for all UNC students by using a hard waiver model with a common base student health insurance plan? The Question Presented to the UNC BOG Can better rates and coverage be obtained for all UNC students by using a hard waiver model with a common base student health insurance plan?

10. The University of North Carolina 10

11. The University of North Carolina 11 UNC System-Wide Student Health Insurance The Answer = The November 2008 RFP results demonstrated that better rates and coverage can be obtained for all UNC students through a hard waiver model with a common base student health insurance plan. The Answer = The November 2008 RFP results demonstrated that better rates and coverage can be obtained for all UNC students through a hard waiver model with a common base student health insurance plan.

12. The University of North Carolina 12 UNC Board of Governors Approval Recommendation to the UNC Board of Governors Approve the use of a hard waiver model in the creation of an RFP with a common base student health insurance plan for all UNC campuses with implementation in Fall 2010. ** Approved unanimously by the UNC BOG on August 14, 2009 Recommendation to the UNC Board of Governors Approve the use of a hard waiver model in the creation of an RFP with a common base student health insurance plan for all UNC campuses with implementation in Fall 2010. ** Approved unanimously by the UNC BOG on August 14, 2009

13. The University of North Carolina 13 UNC System-Wide Student Health Insurance RFP Design Vendor capabilities & requirements Base benefits + campus enhancement options Continuation of coverage provision Dependent coverage for spouse / domestic partner, child(ren) Agreement period: three (3) annual agreements; option for two (2) additional 1-year agreements pursuant to all terms of the RFP and renewal rates being acceptable to vendor and UNC GA RFP Design Vendor capabilities & requirements Base benefits + campus enhancement options Continuation of coverage provision Dependent coverage for spouse / domestic partner, child(ren) Agreement period: three (3) annual agreements; option for two (2) additional 1-year agreements pursuant to all terms of the RFP and renewal rates being acceptable to vendor and UNC GA

14. The University of North Carolina 14 UNC System-Wide Student Health Insurance RFP Design - continued Bid pricing: All students vs. separate pricing for undergraduate and graduate students Vendor administrative requirements o Claims administration services o Accounting & statistical reports o Health insurance coverage verification o On-line waiver system o On-line activation of insurance o Performance metrics for waiver requests o Data transfers: vendor to/from Banner & PeopleSoft RFP Design - continued Bid pricing: All students vs. separate pricing for undergraduate and graduate students Vendor administrative requirements o Claims administration services o Accounting & statistical reports o Health insurance coverage verification o On-line waiver system o On-line activation of insurance o Performance metrics for waiver requests o Data transfers: vendor to/from Banner & PeopleSoft

15. The University of North Carolina 15 UNC System-Wide Student Health Insurance Hard Waiver Participation Requirements Degree-seeking students Eligible to pay campus health services fee Undergraduates = minimum 6 credit hours Graduate students = minimum 6 credit hours except minimum 1 hour at UNC-CH, NCSU, UNCC & UNCW Provision for special student populations o International students o Student internships o Non-degree programs Hard Waiver Participation Requirements Degree-seeking students Eligible to pay campus health services fee Undergraduates = minimum 6 credit hours Graduate students = minimum 6 credit hours except minimum 1 hour at UNC-CH, NCSU, UNCC & UNCW Provision for special student populations o International students o Student internships o Non-degree programs

16. The University of North Carolina 16 UNC System-Wide Student Health Insurance RFP Process 2 nd RFP released on September 9, 2009 5 bids received; opened on October 16, 2009 2 finalists selected for “finalists’ days” on December 7 - 8, 2009 Campus Health Directors received the finalists’ RFP packets without prices prior to the finalists’ days; prices sent to Directors after finalists’ days RFP Process 2 nd RFP released on September 9, 2009 5 bids received; opened on October 16, 2009 2 finalists selected for “finalists’ days” on December 7 - 8, 2009 Campus Health Directors received the finalists’ RFP packets without prices prior to the finalists’ days; prices sent to Directors after finalists’ days

17. The University of North Carolina 17 UNC System-Wide Student Health Insurance RFP Process - continued Each Director submitted via email to Dr. Mallette: o Their campus’ preferred vendor & why o Why they did not prefer the other vendor February 5, 2010: finalist day with UNC General Administration leadership Vendor selection made by UNC GA Vendor announced on February 8, 2010 RFP Process - continued Each Director submitted via email to Dr. Mallette: o Their campus’ preferred vendor & why o Why they did not prefer the other vendor February 5, 2010: finalist day with UNC General Administration leadership Vendor selection made by UNC GA Vendor announced on February 8, 2010

18. The University of North Carolina 18 UNC System-Wide Student Health Insurance Basic Plan $610 per year ($305 per semester) Maximum benefit $100,000 per incident of injury or sickness Prescription drug benefit = $1,000 per year Out of pocket maximum of $2,000 within the PPO / $4,000 outside the PPO Immunizations (e.g., Meningitis, HPV, flu) = $500 per year Evacuation and repatriation Basic Plan $610 per year ($305 per semester) Maximum benefit $100,000 per incident of injury or sickness Prescription drug benefit = $1,000 per year Out of pocket maximum of $2,000 within the PPO / $4,000 outside the PPO Immunizations (e.g., Meningitis, HPV, flu) = $500 per year Evacuation and repatriation

19. The University of North Carolina 19 UNC System-Wide Student Health Insurance Optional Campus Selected Enhancements Maximum benefit in base plan = $100,000 per incident of injury or sickness o $250,000 per incident of injury or sickness o $1,000,000 or unlimited lifetime maximum Deductible in base plan = $300 o $0 deductible or $150 deductible Rx benefit in base = $10 co-pay; $1,000 maximum o No co-pay or unlimited maximum Wellness: maximum $500 per year or unlimited Vision care and preventive dental Optional Campus Selected Enhancements Maximum benefit in base plan = $100,000 per incident of injury or sickness o $250,000 per incident of injury or sickness o $1,000,000 or unlimited lifetime maximum Deductible in base plan = $300 o $0 deductible or $150 deductible Rx benefit in base = $10 co-pay; $1,000 maximum o No co-pay or unlimited maximum Wellness: maximum $500 per year or unlimited Vision care and preventive dental

20. The University of North Carolina 20 UNC System-Wide Student Health Insurance Implementation Weekly conference calls in February - March 2010 Boilerplate announcement & FAQs for each campus to use with their students, parents, and others Implementation web site of tools & tips http://studenthealth.uncc.edu/UNC_SHI_Implementation.htm Each campus selected benefits enhancement options Visit to Pearce & Pearce, Inc. in Florence, SC by all campuses on March 25 - 26, 2010 Students begin requesting waivers on-line for Fall 2010 semester March 15 th - April 1 st Implementation Weekly conference calls in February - March 2010 Boilerplate announcement & FAQs for each campus to use with their students, parents, and others Implementation web site of tools & tips http://studenthealth.uncc.edu/UNC_SHI_Implementation.htm Each campus selected benefits enhancement options Visit to Pearce & Pearce, Inc. in Florence, SC by all campuses on March 25 - 26, 2010 Students begin requesting waivers on-line for Fall 2010 semester March 15 th - April 1 st

21. The University of North Carolina 21 UNC System-Wide Student Health Insurance Implementation – continued Administrative fee (maximum $10 per semester) Coverage dates: waive once, verify twice o August 1 st - December 31 st o January 1 st - July 31 st Common waiver appeals process Common affidavit for domestic partnership Study abroad International students State employees Age 26 and other Federal legislation impacts Implementation – continued Administrative fee (maximum $10 per semester) Coverage dates: waive once, verify twice o August 1 st - December 31 st o January 1 st - July 31 st Common waiver appeals process Common affidavit for domestic partnership Study abroad International students State employees Age 26 and other Federal legislation impacts

22. The University of North Carolina 22 UNC System-Wide Student Health Insurance Why It Worked Commitment from UNC President Erskine Bowles Leadership by Dr. Bruce Mallette, Senior Associate Vice President for Academic & Student Affairs at UNC GA bmallette@northcarolina.edu bmallette@northcarolina.edu Active participation by representatives from NCDOI & NCAIA All 16 Health Directors working together – “think system” and wear the “big” hat perspective and not just “local” Past hard waiver experiences on 11 UNC campuses Why It Worked Commitment from UNC President Erskine Bowles Leadership by Dr. Bruce Mallette, Senior Associate Vice President for Academic & Student Affairs at UNC GA bmallette@northcarolina.edu bmallette@northcarolina.edu Active participation by representatives from NCDOI & NCAIA All 16 Health Directors working together – “think system” and wear the “big” hat perspective and not just “local” Past hard waiver experiences on 11 UNC campuses

23. The University of North Carolina 23 UNC System-Wide Student Health Insurance Why It Worked - continued Involvement of campus student governments Past hard waiver experiences on 11 UNC campuses All 16 Health Directors working together – “think system” Including vendor in conference calls once award was made During implementation -- flexibility by vendor and campuses in “getting to yes” on terms, definitions, and protocols; there are always aspects of the RFP to which clarity, consistency, and consensus must be reached Many, many, many, many conference calls and emails ! Why It Worked - continued Involvement of campus student governments Past hard waiver experiences on 11 UNC campuses All 16 Health Directors working together – “think system” Including vendor in conference calls once award was made During implementation -- flexibility by vendor and campuses in “getting to yes” on terms, definitions, and protocols; there are always aspects of the RFP to which clarity, consistency, and consensus must be reached Many, many, many, many conference calls and emails !

24. The University of North Carolina 24 UNC System-Wide Student Health Insurance Reminders Voluntary insurance o Sell insurance to fewer than 10% of students Hard waiver insurance o Sell to all students (and parents) o Waiver process as important as access to SHI o Waivers will take up most of your time o Importance of having health insurance as a life lesson UNC estimates o 60,000 will buy SHI o 140,000 will waive out or are ineligible Reminders Voluntary insurance o Sell insurance to fewer than 10% of students Hard waiver insurance o Sell to all students (and parents) o Waiver process as important as access to SHI o Waivers will take up most of your time o Importance of having health insurance as a life lesson UNC estimates o 60,000 will buy SHI o 140,000 will waive out or are ineligible

25. The University of North Carolina 25 UNC System-Wide Student Health Insurance Thank you Questions & Answers Resource: UNC BOG materials are at www.northcarolina.eduwww.northcarolina.edu o Click on Leadership o Click on Board of Governors o Click on Pre-meeting Materials o Click on 2009 and May 8 th ; see pdf files under Policy Discussion o Click on 2009 and August 14 th ; see pdf files under Policy Discussion Thank you Questions & Answers Resource: UNC BOG materials are at www.northcarolina.eduwww.northcarolina.edu o Click on Leadership o Click on Board of Governors o Click on Pre-meeting Materials o Click on 2009 and May 8 th ; see pdf files under Policy Discussion o Click on 2009 and August 14 th ; see pdf files under Policy Discussion