WHITE PAPER
ON
STUDENT HEALTH INSURANCE
FOR
MINNESOTA STATE COLLEGES AND UNIVERSITIES
CHIEF FINANCIAL OFFICERS CONFERENCE
December 2013
NOTE: The recommendation offered below has been distributed to presidents, CFOs,
CAOs, CSAOs, student organizations and the student health insurance task force for
review and comment. There has been wide support to date for the recommended approach.
Comments close December 20, 2013.
Purpose: Provide a recommendation concerning the future of system selected student health
insurance, given the implementation of the Affordable Care Act (ACA).
Background: Minnesota State Colleges and Universities (MnSCU) offers student health
insurance benefits to students within the system under authority granted in Minnesota Statute
136F.20:
136F.20 STUDENT HEALTH.
Subdivision 1.Health service.
The board shall offer health services for students at each state university and
may offer health services for students at each state college. The health services may
be offered either on campus or in the nearby community. The board may charge each
student a health service fee set by the board. The fees shall be used to maintain the
health service and equip and construct facilities. The fee may be used to contract for
health, medical, and hospitalization insurance for students. The fees shall be
deposited in an activity fund and are annually appropriated to the board for the
purposes of this subdivision. Each state college and university shall provide an
annual financial accounting of the health service money to the board.
Subd. 2. Health benefits.
The board may contract for hospital benefits coverage and medical benefits
coverage for students in the state colleges and universities in the same manner as
authorized by section 43A.23 for state employees.
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History:
1995 c 212 art 4 s 19
Note: 2014 Unsession proposal includes changing “shall” to “may” in
subdivision 1, first sentence.
MnSCU provides a group contract for student health insurance through UnitedHealth Group. The
system requires all international students and all student athletes to purchase system offered
health insurance. The program is administered as a “hard waiver” program, meaning students are
enrolled until they affirmatively prove alternative coverage in place, consistent with applicable
policy. The requirement for international students is in place in order to demonstrate economic
self-sufficiency to enroll in a MnSCU institution as required by federal immigration regulations.
The requirement concerning student athletes reflects concerns of a much higher risk of injury.
The system also offers a “soft waiver” program available to interested institutions. A soft waiver
program enrolls all students, then, releases them upon their request, and without requiring
evidence of alternative insurance.
As of benefit year 2011, there are 3,533 (less than 1%) students enrolled in health insurance
through the system contract:
International students:
Student Athletes:
General Students:
2,685 .06% of total enrollment;
(75% of international student enrollment)
72 .0002%
749 .002%
The implementation of the Affordable Care Act (ACA) changes the coverage and finance
options offered by insurers and impacts the options available to students and the system. The
review of this program included several planning assumptions.
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Effective tax year 2014, the ACA mandates individual health insurance or payment of an
escalating penalty.
ACA has established certain coverage minimums (individual mandate).
Some students (under the age of 26) will have coverage through their parent’s plan,
others will not.
Some students will have employer provided health insurance, some will not.
Some students will choose not to have coverage and instead incur the penalty.
Students buying through the state health exchange will have access to the discounts and
subsidies offered by the federal and state sponsored program – discounts and subsidies
that will reduce the cost compared to the MnSCU program.
International students, with student visas, are eligible to participate in the ACA, including
MNsure. Other international students may also be eligible depending upon their visa
status. (Note: we continue to work to establish absolute clarity on the matter of eligibility.
The recommendation below was crafted in part to allow time for this issue to solidify)
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State Sponsored ACA Program
The ACA open enrollment period is October 1, 2013 to March 31, 2014. The state exchange
market (MNsure) is designed to provide individuals the opportunity to customize a plan
specifically to meet their personal needs, i.e. high deductible-low premium or low deductiblehigh premium plans.
 Applicants may qualify for Medical Assistance (MA) or MinnesotaCare depending on
their annual household income.
 Individuals with annual income <$15,281 will qualify for Medical Assistance. The
insurance plans will be free for those who qualify.
 Individuals with an annual income between 133% & 200% of the Federal Poverty Level
($15,282 - $22,980) will qualify for MinnesotaCare which has its own discounted
premium estimator.
 For those choosing to go uninsured the tax penalty is $95 for 2014, increasing 1% of their
annual income each year thereafter.
 It is not known at this time if the available ACA options will include repatriation and
medical evacuation coverage for international students.
MNsure has trained assisters, brokers, navigators and certified counselors available to assist
individuals in navigating the MNsure website. Each county has these resources available.
MNsure also has 30 organizations available to help citizens throughout the state enroll in the
MNsure program.
According to research done by the U.S. Department of Health and Human Services and the
Minnesota Department of Commerce, MNsure plans will have the lowest premium rates in the
nation. However, premiums will vary across the state. For example a 25-year-old living in the
Twin Cities could pay approximately $1440 annually for a mid-level plan, whereas that same
individual living near Rochester choosing a comparable plan will pay $2772.
--- MPR article September 27, 2013
A review of the MNsure website and a calculation of a “typical” MnSCU student finds that for
all students with income less than $23,000, the MNsure premium would be 10-30 percent of the
current MnSCU offered plan premium. As incomes approach $46,000 and plan choices move up
the optional service level scale, the MNsure quoted premiums approach the current MnSCU
premium. The state/federal premium discounting stops at incomes above $46,000. Thirty percent
of MnSCU’s 2012 students, with dependents, reported income below $46,000. Ninety percent of
independent students report incomes less than $49,000.
Thus, it appears that for the great majority of MnSCU students, the new MNsure options will
offer better coverage and value than the current MnSCU policy.
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Recommendation
The advent of the ACA and the plans available through the state has changed the landscape for
individual health insurance. The state sponsored plans include rate structures in the individual
market place that are very attractive. The system’s current participation rate, at less than 1
percent of all students, argues for limited continued programming. The current provider has
indicated a willingness to offer a mandatory plan for international students. It would remain
possible to require insurance of student athletes, purchased through the state program at
discounted rates.
Therefore, the recommendation is to continue to offer a “hard waiver” insurance plan to
international students and to discontinue other offerings. It is also recommended that the
program be re-examined in a year to evaluate the marketplace options for international students.
Transition Plan
The system’s current provider has indicated a willingness to operate the current program through
August, 2014. Communication with students, campus admissions staff, advisors, counselors,
health services staff, international student advisors, athletic staff and administrators should begin
immediately so that those students participating as student athletes or through the voluntary
program can enroll elsewhere during the MNsure open enrollment period (October – March,
2014). The system should begin pursuit of a new program for international students in order to
have coverage in place by July 1, 2014.
Area of Continuing Study
The task force also identified the need for a system examination of the role, funding and future
for on campus health services. Ten colleges and six universities assess students a per credit fee to
support on-campus student health services. The service demands placed upon the on-campus
services have changed dramatically in the past ten years. Implementation of the ACA may also
create additional referral and reimbursement requirements for the on campus services.
Without a MnSCU offered plan, schools with a health service centers will need to apply to
numerous healthcare providers in order to be considered an “in-network” provider to service our
students at a lower cost. The campuses and the student associations are interested in continuing
to study the health services program in the year ahead. This effort will lead to recommendations
to the Leadership Council and the Chancellor in preparation for the 2015 or 2016 fiscal year.
Communication Plan
System office staff will work with the student associations and members of the task force to
develop and implement a communication plan regarding any changes to the program. It is
important that communication start right after the first of the year in order to direct current
student enrollees to the MNsure website immediately. The state’s open enrollment period closes
March 31, 2014. Existing and new communication channels will need to be used in order to
reach the 800+ students currently participating In the MnSCU sponsored program.
Submitted by Vice Chancellor Laura King, Vice Chancellor - CFO
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Attachments: Current college/university participation pattern
Student health Insurance Task Force roster
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College/University Participation Patterns
Enrollment breakdown by institution as of December 2012:
VOLUNTARY PLAN - 24 institutions with 212 students participating
Universities: Metropolitan State University, Minnesota State University, Mankato, St. Cloud
State University, Southwest Minnesota State University, Winona State University
Colleges: Alexandria Technical College, Anoka Ramsey Community College, Century College,
Dakota Community and Technical College, Fond Du Lac Tribal and Community College,
Hennepin Technical College, Inver Hills Community College, Lake Superior College,
Minneapolis Community and Technical College, Minnesota State College – Southeast Technical,
Minnesota State Community and Technical College, Normandale Community College, North
Hennepin Community College, Northland Community and Technical College, Pine Technical
College, Rochester Community and Technical College, Saint Paul College, Ridgewater College,
Vermilion Community College
WAIVER PLAN - 2 institutions with 537 students participating
Universities: Bemidji State University, Minnesota State University Moorhead
ATHLETIC PLAN - 5 institutions with 72 students participating
Universities: Bemidji State University, Minnesota State University Moorhead, Minnesota State
University, Mankato, St. Cloud State University
Colleges: Dakota Community and Technical College
INTERNATIONAL PLAN - 25 institutions with 2,685 students participating
Universities: Bemidji State University, Metropolitan State University, Minnesota State
University, Mankato, Minnesota State College Moorhead, St. Cloud State University, Southwest
Minnesota State University, Winona State University
Colleges: Alexandria Technical College, Central Lakes College, Century College, Dakota
Community and Technical College, Hennepin Technical College, Inver Hills Community
College, Minneapolis Community and Technical College, Minnesota West Community and
Technical College, Minnesota State Community and Technical College, Normandale
Community College, North Hennepin Community College, Northland Community and Technical
College, Ridgewater College, Riverland Community College, Rochester Community and
Technical College, South Central College, St. Cloud Technical and Community College,
Vermilion Community College
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Student Health Insurance Task Force Roster
University CFOs
Scott Ellinghuysen (WSU)
Rick Straka (MSU, M)
Murtuza Siddiqui (Metro State)
Jan Mahoney (MSUM)
Deb Kerkaert (SMSU)
Bill Maki (BSU)
College CFOs/Business Managers
Marilyn Smith (ATC)
Kari Christensen (CLC)
Bonnie Meyers (Century)
Advocates
Pam Rasmussen (WSU)
Kimberly Schulz (BSU)
Kathryn Grant (MSU, M)
Coralee Cronin (SCSU)
MSUSA
Elsbeth Howe (MSUSA)
Shannon Killeen (WSU student)
MSCSA
Steve Sabin (MSCSA)
Jessica Medaris (MSCSA)
Richard Barnier (Student – 2 yr)
Student Health Services Directors
Wendy Schuh (MSU, M)
Connie Kamara (WSU)
Carol Grimm (MSU, M)
2 Year CAOs
Lisa Wheeler (Normandale)
Landon Pirius (NHCC)
Beth Adams (CLC)
International Advisor
Herbert King (Century)
University CAOs
Mary Ward (BSU)
David Jones (MSU,M)
Medical Director
Brent Nielson
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