GA Insurance - Background - Department of Human Resources

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2013-14
Graduate Assistant
Plan Changes
MAY 16, 2013
LORI VIVIAN, HUMAN RESOURCES
MIKE KURLAND, STUDENT HEALTH SERVICES
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
- 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
CIGNA
Nationwide
700,000
Included
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
None
$0 students seen at SHS, $0 adult physical exams, $25 all
other
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
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
GA Only
GA + 1
Family
$ 200
$1,440
$1,822
Paid by UConn
Total
$ 3,730
$ 8,160
$10,328
$ 3,930
$ 9,600
$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
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