MAY 16, 2013

LORI VIVIAN, HUMAN RESOURCESMIKE KURLAND, STUDENT HEALTH SERVICES

2013-14Graduate Assistant

Plan Changes

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

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

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) UConn’s 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)

Administrative Challenges

State’s 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

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

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

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

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

GA vs. Student Insurance Comparison

Key Features GA Plan Student Plan (2013-14)Network    - Carrier Anthem Blue Cross Blue Shield CIGNA- Service area of network providers CT only Nationwide- Number of providers 15,000 – 16,000 700,000- Out of network coverage Available to GAs for additional cost Included     

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 student’s 10%

reaches $5,000- Emergency room 100% paid by plan 100% paid by plan if admitted, $150 copay if not admitted- Outpatient surgery 100% paid by plan 90% paid by plan- Laboratory 100% paid by plan 90% paid by plan- X-rays 100% paid by plan 90% paid by plan- Annual deductible None $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 GA’s 30% reaches $3,000

70% paid by plan after student pays $500 annual deductible, 100% paid by plan when student’s 30% reaches $5,000

     

Prescriptions $10 generic $20 preferred brand $30 non-preferred brand

$15 generic $30 brand name

     

Medical Evacuation and Repatriation None Included     

Effective Date of Coverage September 1 (Note: GAs required to have coverage while at school, students without coverage must purchase short-term medical policy)

August 15

Annual Cost of New Plan

Paid by GA Paid by UConn Total

GA Only $ 200 $ 3,730 $ 3,930GA + 1 $1,440 $ 8,160 $ 9,600 Family $1,822 $10,328 $12,150

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

Next Steps

Finalize details of the plan design

Determine the premium collection process

Develop enrollment process Continuing GAs Incoming/new GAs

Communicate, communicate, communicate

Questions