GA Insurance - Background - Department of Human Resources

Graduate Assistant
Plan Changes
MAY 16, 2013
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
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
 Plan design had MANY inside maximums and variations (dated plan design)
 Coverage was limited. Hard to administer and understand for a consumer
 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
 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)
 Removed inside Plan Maximum of $5,000 ( surgical, MH etc.)
 Removed the exclusion for sexual reassignment surgery
 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
 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)
- Carrier
- Service area of network providers
- Number of providers
- Out of network coverage
Anthem Blue Cross Blue Shield
CT only
15,000 – 16,000
Available to GAs for additional cost
Healthcare Services - Network Provided
- Office visit copays
$10 primary care, $20 specialists, $35 urgent care
- Hospital
$250 copay, then 100% paid by plan
- Emergency room
- Outpatient surgery
- Laboratory
- X-rays
- Annual deductible
100% paid by plan
100% paid by plan
100% paid by plan
100% paid by plan
$0 students seen at SHS, $0 adult physical exams, $25 all
90% paid by plan, 100% paid by plan after student’s 10%
reaches $5,000
100% paid by plan if admitted, $150 copay if not admitted
90% paid by plan
90% paid by plan
90% paid by plan
$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
$10 generic
$20 preferred brand
$30 non-preferred brand
$15 generic
$30 brand name
Medical Evacuation and Repatriation
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
GA Only
GA + 1
$ 200
Paid by UConn
$ 3,730
$ 8,160
$ 3,930
$ 9,600
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
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