University Health Plans, Inc.
Student Health Insurance Plan
Presented to:
UNIVERSITY HEALTH PLANS
UHP’s Success
•20+ years experience
•Pioneered web-based enrollment/waiver system
•100% Student Health Programs
•60 College and University Clients
•Accountable Management/Decision Making
UNIVERSITY HEALTH PLANS
UHP’s Client Services
•Represent the Client
•Competitive Premiums
•Enrollment/Waiver Billing
UNIVERSITY HEALTH PLANS
UHP’s Client Services (continued)
•Customer Service
•Student/Client Advocate
•Secure Website
•Toll Free Number
•On-Site Training Available
UNIVERSITY HEALTH PLANS
UHP’s Client Services (continued)
•Quarterly reviews/discussions
•Plan Evaluation/Plan Design
•Claim Reports
- detailed claims analysis
- claim run-out
- prescription drug detail
UNIVERSITY HEALTH PLANS
UHP Client Services (continued)
•UHP claims audits
•UHP is the student/client advocate
•UHP’s complimentary products
•State Reports
UNIVERSITY HEALTH PLANS
www.universityhealthplans.com
Customized On-Line Services
UHP has developed several on-line resources to meet the needs
of each school:
•Brochures and other forms on-line or downloadable
•On-Line Waiver and Enrollment
•On-Line Eligibility look-up
•On-Line Claims Status look-up
•On-Line ID Card request
•Preferred Provider and Member Pharmacy look-up
BCBSMA Promise
To Always Put Our Members’ Health First
Our Mission…Our Philosophy
Blue Cross Blue Shield:
• Social Contract
• Long-term cost & quality focus
• 1% - 2% contribution to reserves
• Views healthcare delivery and administration as local with a national reach (one size
does not fit all)
Your long-term partner should have a longterm vision
Blue Cross Blue Shield of Massachusetts
World Class Performance...
Sustained Excellence
Membership & Growth
Year end 12/31/06
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•
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Service Excellence
Year end 12/31/06
Total Members
3,050,000
New members
128,800
Dominant market share 40%
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•
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Strong Member Satisfaction 85%
Strong Provider Satisfaction 88%
Account Retention
95.8%
Financial Stability
Year end 12/31/06
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•
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Blue Cross Blue Shield of Massachusetts
Earned Premiums
Cash & Investments
After Tax Net Income
Statutory Reserves
$6.81B
$2.6B
$122M
$1.6B
Why Choose Blue?
Brand Strength
The Blues are the Brand leaders among employers and
consumers
Unaided Brand Awareness
• #1 market share in all 50 states
71%
• Most recognized brand in
healthcare among consumers
• #1 in delivering the lowest overall costs
(Fortune Magazine, Sept. 2005)
24%
Aetna
United
CIGNA
18%
10%
Source: Brand Strength Measure Survey (2005)
Blue Cross Blue Shield of Massachusetts
• 75% of Fortune 100 companies (9 of
the top 10)
• 94 Million covered lives (1 in 3
Americans)
Network Access and Discounts
The Blue Cross Blue Shield
Network Advantage
Local Networks
• Over 15,000 providers*
• 85 hospitals
• Stable mature networks (consistent local benefit delivery)
Regional Networks
• Over 32,000 providers*
• 181 hospitals throughout New England
• Stable mature networks (consistent regional benefit delivery)
National Networks
•
•
•
•
Over 1,000,000 providers*
Over 6,000 hospitals
Stable, mature networks (consistent national benefit delivery)
Only nationwide network with secondary and rural locations
*Includes Adult
PCPs,
Pediatricians,
Ob/Gyns,
Specialists
Blue Cross Blue Shield of Massachusetts
Benefit to
Bentley College
More claims processed in-network
provides savings; unsurpassed access to
care allows consolidation ease
The Blue Cross Blue Shield Network Advantage (cont.)
Assessing network value:
•
Low unit cost (per claim discounts)
•
Care Management (utilization controls)
•
Depth & Breadth of networks (access to care)
Blue Cross Blue Shield
is the recognized industry leader in network value
Blue Cross Blue Shield of Massachusetts
Healthy Member Interventions
Prevention and wellness communications and programs
• Healthy Blue Programs
• Worksite Wellness Programs
Comprehensive e-health and communication strategies to address a large population with noncomplex health issues
• www.ahealthyme.com
• www.bluecrossma.com
Blue Cross Blue Shield of Massachusetts
Award Winning Web Sites
Healthy Blue Programs
Support:
Incentives:
• LIVING HEALTHY Babies
• Fitness Benefit - $150 per yr.
• Living Healthy Smoke-Free
• Weight Loss Benefit - $150 per yr.
• Blue Care Line – 24/7; (888) 247-BLUE
• Discounts (bike helmets, safety products)
• DecisionCare Guide
• Living Healthy Naturally:
— 20% discount on acupuncture, massage
therapy, nutrition counseling
Campus Wellness
• Healthy Blue at School
• Personal Edge (fee for service)
Blue Cross Blue Shield of Massachusetts
• Living Healthy Vision:
— Up to 25% discount (frames, lenses,
contacts)
Care Management
Program Goals
• improve health status, quality of life, lower rates of complication and inpatient admissions
Member Identification
• claims data, PHRAs, episodes of care, physician referral, member referral
Specialized Programs
• transplants
• outpatient therapies
• pediatric focus
• rare diseases – multiple sclerosis, cystic fibrosis, Parkinson's
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield’s View of the Future…
Old Thinking: Quality is a given. So,
contain costs.
New Thinking: Promote quality and costs
will be contained.
• Gaps in care
• Fewer adverse events
• Unsustainable rise in costs
• Reduced waste
• Think once, Order twice
• Think twice, order once
• Pay for metrics (HEDIS based)
• Pay for performance (evidence based)
© 2006 Blue Cross Blue Shield Association. All Rights Reserved.
Blue Cross Blue Shield of Massachusetts
Claims Processing
• Average turnaround time – 3.6 days (year end 2006)
• Auto adjudication rate – 91.2% (year end 2006)
• Claim payment accuracy – 99.7% (year end 2006)
• Financial accuracy – 99.9% (year end 2006)
Blue Cross Blue Shield of Massachusetts
BCBSMA Student Business
• History
—
Harvard University
—
Massachusetts Institute of Technology
—
Northeastern University
—
UMass Dartmouth
—
UMass Worcester
—
Berklee College of Music
• Underwriting Rationale
Blue Cross Blue Shield of Massachusetts
Bentley College Student Plans
• PPO Benefit Plan
— Referrals not required
— 100% in-network nationally
— 80% out-of-network nationally
Blue Cross Blue Shield of Massachusetts
PPO Benefits (option 1 – 100/80)
Benefit
In-Network
Out-of-Network
Maximum
Unlimited
Unlimited
Deductible
None
$250 per member
Office Visits
$15 Co-Pay then 100%
20%*
Emergency Room
$50 Co-Pay then 100%
$50 Co-Pay the 100%
Maternity Care (inpatient)
No charge
20%*
Vision Exam
Co-Pay then 100%
20%*
$10/$25/$45Co-Pay **
Not Covered
(1 per 24 mos.)
Prescription Drugs (ESI)
*Deductible applies
**No annual maximum
Option 1 = $984.00 annual student rate (add $5.00 for on-call travel assist and $3.00 for $10,000 AD&D
coverage)
Blue Cross Blue Shield of Massachusetts
PPO Benefits (option 2 – 90/70)
Benefit
In-Network
Out-of-Network
Maximum
Unlimited
Unlimited
Deductible
$250 per member***
$250 per member***
Office Visits
$15 Co-Pay then 100%
20%*
Emergency Room
$100 Co-Pay then 100%
$100 Co-Pay then 100%
Maternity Care (inpatient)
10%*
30%*
Vision Exam
$15 Co-Pay then 100%
20%*
$10/$25?$45 Co-Pay **
Not Covered
(1 per 24 mos.)
Prescription Drugs (ESI)
*Deductible applies
**No annual maximum
***In and out-of-network combined
Option 1 = $891.00 annual student rate (add $5.00 for on-call travel assist and $3.00 for $10,000 AD&D
coverage)
Blue Cross Blue Shield of Massachusetts
PPO Benefits (option 3 – 80/60)
Benefit
In-Network
Out-of-Network
Maximum
Unlimited
Unlimited
Deductible
$250 per member***
$250 per member***
Office Visits
$20 Co-Pay then 100%
20%*
Emergency Room
$100 Co-Pay then 100%
$100 Co-Pay then 100%
Maternity Care (inpatient)
20%*
40%*
Vision Exam
$20 Co-Pay then 100%
20%*
$10/$25/$45 Co-Pay **
Not Covered
(1 per 24 mos.)
Prescription Drugs (ESI)
*Deductible applies
**No annual maximum
***In and out-of-network combined
Option 1 = $802.00 annual student rate (add $5.00 for on-call travel assist and $3.00 for $10,000 AD&D
coverage)
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield
Member Services
Blue Cross Blue Shield of Massachusetts
Why Choose Blue?
•
Brand strength and value
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Network access and discounts
•
Innovative products and health care solutions
•
World class concierge service
Uniquely positioned to be Bentley College’s long-term
partner
Blue Cross Blue Shield of Massachusetts
Nationwide Life Insurance Company
Nationwide Life Insurance Company
Nationwide Facts:
•Rated A+ by A.M. Best
•Insuring student plans for over 6 years
•$100 Million in student insurance premium
•$30 Million in UHP/Nationwide premium
•Access PPO’s for best possible discounts, including
Multi-Plan/PHCS and FirstHealth (HCVM, CCN)
•ExpressScripts Rx Plan
Consolidated Health Plans (CHP)
Claims Administration Services
CHP Facts:
•Headquartered in Springfield, MA
•Providing claims payments services for over 10 years
•Over 100 College and University clients
•$40 Million in paid claims
•Flexible Benefits
Consolidated Health Plans (CHP)
Claims Administration Services
CHP Claims Payment Statistics:
•Average turn around time 5-7 business days on “clean”
claims
•Payment at 99% accuracy
•Random audits performed to ensure consistent accuracy
•Utilization review on claims over $10,000
Consolidated Health Plans (CHP)
Claims Administration Services
CHP Customer Service Statistics:
•Same day response for calls received before 2:00 pm
•24 hour response time for all email inquiries
•Continual customer service training to ensure accuracy of
responses
Consolidated Health Plans (CHP)
Claims Administration Services
CHP On-Line Services:
•Available 24/7
•Eligibility status look-up
•Claims status inquiry
•On-Line “EOB”, including date of service, payment date,
PPO savings, patient responsibility, etc.
•Preferred provider look-up
•On-line/printable brochure
Member Services
Nationwide Life Insurance Company
Option 1
Benefits
Aggregate Maximum
Physician's Office Visit
$50,000 Per Condition per Policy Year
100% after $15 Copay In-network or $25 Copay Out-of-Network
Emergency Room
80%
Inpatient Hospitalization
80%
Surgical Charges
80%
Lab and X-Ray
Prescription Drugs
80% (100% for labs when samples are taken or drawn at Health Services)
100% after $10 copay for generic or $15 copay for brand name
$500 maximum per Policy Year
Premiums
Student Only
$828.00
Spouse Only
$1,800.00
Child Only
$1,325.00
2nd Year Cap of no more than 14%
Nationwide Life Insurance Company
Option 2
Benefits
In-Network
Out-of-Network
$50,000 per condition per policy year
$50,000 per condition per policy year
80% after $15 copay
70% after $15 copay
Emergency Room
80%
70%
Inpatient Hospitalization
80%
70%
Surgical Charges
80%
70%
Lab and X-Ray
80% (100% for labs when samples are
taken or drawn at Health Services)
70% (100% for labs when samples are
taken or drawn at Health Services)
Prescription Drugs
($500 max per policy year)
100% after a copay of $10 generic or
$15 for brand name
100% after a copay of $10 generic or $15
for brand name
Aggregate Maximum
Physician's Office Visit
Premiums
Student Only
$814.00
Spouse Only
$1,790.00
Child Only
$1,300.00
2nd Year Cap of no more than 14%
Nationwide Life Insurance Company
Option 3
Benefits
In-Network
Out-of-Network
$50,000 per condition per policy year
$50,000 per condition per policy year
100% after $15 copay
80% after $15 copay
Emergency Room
100%
80%
Inpatient Hospitalization
100%
80%
Surgical Charges
100%
80%
Lab and X-Ray
100%
80% (100% for labs when samples are
taken or drawn at Health Services)
100% after a copay of $10 generic or
$15 for brand name
100% after a copay of $10 generic or $15
for brand name
Aggregate Maximum
Physician's Office Visit
Prescription Drugs
($500 max per policy year)
Premiums
Student Only
$915.00
Spouse Only
$2,000.00
Child Only
$1,450.00
2nd Year Cap of no more than 14%
Nationwide Life Insurance Company
Benefit Modifications
Benefit Modification
Student Only Rate
(Dependents will be proportional)
1.) Increase maximum prescription drug coverage to $750
$18
2.) Immunizations (all combined)
$11
3.) Routine physicals (up to $100 per year)
$12
4.) STD screening package (all combined)
$10