1 / 104

Student Health Insurance/Benefit Plans:

Student Health Insurance/Benefit Plans:. Adapting to the Environment Post Affordable Care Act (ACA). Achieve. Build. Envision. Presenters. Jenny Foss Director, Student Health Services, Old Dominion University Valerie Lyon Associate Director of Business & Finance

youngr
Download Presentation

Student Health Insurance/Benefit Plans:

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Student Health Insurance/Benefit Plans: Adapting to the Environment Post Affordable Care Act (ACA) Achieve Build Envision

  2. Presenters Jenny Foss Director, Student Health Services, Old Dominion University Valerie Lyon Associate Director of Business & Finance Gannett Health Services, Cornell University

  3. Presenters Susann Jackson Director, Student Health Benefits Boynton Health Services, University of Minnesota Diane Plumly Director, Student Health Insurance The Ohio State University

  4. Objectives • Discuss current implications of the ACA on student health insurance/benefit plans • Identify strategies to adapt to recent changes & trends, including the impact of the health insurance marketplace, the expansion of Medicaid & marketing student health insurance/benefit plans • Review results of the Spring 2014 ACHA Student Health Plan Survey

  5. Disclaimer Note: ACHA advises that you consult your own institution’s legal counsel, risk management office, health insurance plan administrator, or other appropriate institutional officials in determining the insurance plan design and details for your institution's college students

  6. ACHA Standards Student Health Insurance Coverage • May 2013 ACHA Standards Revised by SHIBP Coalition in collaboration with ACHA • Apply to both fully insured and self funded plans • Include following both federal & state mandates including the Affordable Care Act, plans that students can rely on for their primary source of health insurance

  7. Self-Funded Plans as MEC • June 2013 HHS designated self-funded student health plans as Minimum Essential Coverage (MEC) satisfying individual mandate for plans starting on or before 12/31/14 • After 12/31/14, required to go through certification: www.gpo.gov/fdsys/pkg/FR-2013-08-30/pdf/2013-21157.pdf

  8. Contraception Coverage • June 2013 HHS, DOL and Department of Treasury Final Rule on Contraception Coverage and Religious Organizations • Religious employers exempt from the mandate to cover contraceptives for their employees (FMI see FAQ Q.12) • Accommodations for student health insurance coverage by eligible organizations (religious institutions of higher education); organization does not have to provide/pay for contraceptive coverage BUT • Separate payments for contraceptive services are available for women at no cost to the women or the plan.

  9. Internal Revenue Service • July 2013 IRS posted Notice 2013-41: Eligibility for MEC for Purposes of the Premium Tax Credit, contained guidance for students who have access to coverage institution’s self-funded plan, determines their eligibility for MEC “only if the student is enrolled in the coverage” • Students who have access to coverage under a self-funded plan (but are not

  10. IRS • enrolled), would also have the option to purchase coverage through an Affordable Insurance Exchange & be eligible for premium tax credits. • FMI, see: http://www.irs.gov/pub/irs-drop/n-13-41.pdf

  11. Health Insurance Marketplace • October 1, 2013 Health Insurance Marketplace (Exchanges) opened to provide consumers with a new way to shop for, compare costs & coverage benefits & enroll in coverage at www.healthcare.gov • Marketing challenges for student plans

  12. CMS CCIIO Regulatory Guidance • October 2013, the Centers for Medicare & Medicaid Services Center for Consumer Information & Insurance Oversight issued guidance for obtaining recognition as MEC, including applying through the Health Insurance Oversight System (HIOS) for self-funded student health coverage for plan or policy years beginning after December 31, 2014

  13. Transition Relief • November 2013 President Obama: states could delay for 1 year some ACA requirements for small group & individual policy renewals occurring between 1/1/2014 and 10/1/2014 • the bar against discrimination in premium pricing based on health status; • The ban on pre-existing condition exclusions

  14. Transition Relief • coverage of essential health benefits • Some states declined to implement transition relief • Contact your carrier FMI • Consider ACHA Standards on Student Health Insurance Coverage (includes coverage of pre-existing conditions)

  15. The Present • Due to technology challenges, Marketplace sign up for 2014 extended through 3/31/2014 • April 2014 8 million Americans have signed up for coverage through Marketplace Exchanges • 28% of those under age 35; of those who signed up in March, 31% under age 35

  16. 2014 Individual Coverage Mandates • Individuals (unless excluded or exempted) required to obtain MEC for themselves & dependents or pay a penalty $95/adult ($47.50/child), up to $285/family or 1% of family income, whichever is greater • 2015, increases to $325/adult ($162.50/child), up to $975/family or 2% of family income • 2016, increases to $695/adult ($347.50/child), up to $2,085/family or 2.5% of family income • MEC includes: Medicare, Medicaid, a Children's Health Insurance Program, TRICARE and veteran's health care program; • Health insurance coverage offered in a state's individual market;

  17. Excluded from Individual Mandate • Exempt noncitizens, defined as non-US citizens or non-US nationals either (1) in US unlawfully or (2)are nonresident aliens • Incarcerated individuals, religious conscience objectors or members of health care sharing ministry

  18. Exemptions from Paying Penalty • Individuals who have unaffordable coverage, or have income below the threshold for filing tax return, members of Indian tribes, individuals whose first coverage gap of calendar year lasts less than 3 months, and those who apply for and receive hardship exemption from HHS

  19. 2014-2015 Changes • Unlimited Annual Maximum • Student Health Insurance Plans (SHIP) required to cover all EHB (unless transition relief applies) • Pre-existing condition exclusions for all individuals regardless of age are prohibited (unless transition relief) • Deductibles, co-pays& co-insurance all apply toward Out-of-Pocket Maximum

  20. 2014-15 Metal Levels and AV • Student Health Insurance plans required to report metal level & corresponding Actuarial Value (AV) within + or – 2 points • AV measures the generosity of benefits & indicates the average share of medical spending that is paid by the plan, as opposed to being paid OOP by the consumer

  21. AV & Metal Tier Levels • AV values categorize plans into tiers: • Bronze 60% (AV 58-62%) • Silver 70% (AV 68-72%) • Gold 80% (AV 78-82%) • Platinum 90% (AV 88-92%) • Does not apply to self-funded plans • ACHA Advocacy for flexibility

  22. Employer Shared Responsibility • February 2014 Final Rule Employer Shared Responsibility provisions • Hours of service for section 4980H do not include hours of work performed by students in positions subsidized through federal or state work study programs or in non-paid internships/externships

  23. Employer Shared Responsibility • Full-time employees working 30 hours/week for more • Will apply to employers with 100 or more full-time employees starting in 2015 and with 50 or more full-time employees starting in 2016 • See US Treasury Department Fact Sheet Final Regulations Implementing Employer Shared Responsibility under ACA 2015.

  24. Medicaid Expansion April 2014

  25. Cornell University (CU) • Cornell University • Ivy League, Research Institution • Located in Ithaca New York (4 hours from NYC) • 22,000 students • 13,500 undergraduates • 7,500 graduate and professional • Rurally isolated (one hospital and physician group)

  26. CU Student Health Insurance Plan • ACA compliant • 2013-14 premium: $2,212 • 90.13% Actuarial Value • Platinum level plan at Bronze level price • Excellent local and national participating provider network • Unlimited worldwide travel assistance services

  27. Cornell UniversitySHIP enrollment • New York State • SHIP in Lieu of Medicaid • 10,374 students enrolled (~50% student body) 30% of Undergraduate 91% of Graduate 57% Professional (Vet, Law, Business) 90% International • 180 Spouse/Domestic partner • 160 Child(ren)

  28. Post ACA – trends • Expansion to age 26 • Employer cost shifting • 25% of employers offering Account Based Health Plans only (high deductible >$1500) • Provider networks narrowed to control costs • Health Insurance Marketplace opened 10/1/13 • Medicaid eligibility expanded in New York • Now 138%-155% of Federal Poverty Level

  29. Post ACA - Strategies • Medicaid Expansion • Cornell and New York State Department of Health (NYSDOH) - pilot • Premium payment plan (SHIP premium) • $1,000 savings per student in NYS Medicaid costs • Plan designed to mirror Medicaid benefits with fee for service Medicaid as secondary or wrap-around insurance coverage • ~300 undergraduate NYS resident students will qualify, future expansion to independent students

  30. Post ACA - Strategies • Waiver requirements • 2013 – major overhaul to address all ACA trends • Plans marketed to International Students • Denied waivers of plans with unacceptable exclusions listed in plans marketed to international students (e.g. suicide, alcohol/drug conditions, STIs, etc.) • Denied waivers of plans that had low dollar limits • Denied waivers of plans that require you to leave US to return to country of origin, or home country for care.

  31. Post ACA- Strategies • Waiver Requirements - 2013 • Set deductible limit to $2,500 • In response to doubling of students waiving with high deductibles and access to care concerns • Continued definition of “in-network” coverage • 70% or silver level • Teeing up definition to match ACA AV level language • Address narrow network plans ( Exchange and HMO plans from out of area)

  32. Post ACA -Strategies • Modified waiver requirements • Lessons learned from 2013 experience • Required International Students to be on SHIP • Institutional and community • Removed deductible requirement • Feedback from parents • Account Based Health Plans (ABHPs) – mainstream as health insurance coverage (25% of all employers only offer ABHPs) • 2014 ACA OOPL: $6,350 per individual and $12,700 for family • “In-network” threshold held at 70% (silver plan)

  33. Post ACA - Strategies • Educate key stakeholders • Senior Staff • Campus Partners (financial aid, graduate school, international student and scholars office, human resources - employee benefits) • Government relations, local navigators

  34. Post ACA - Strategies • Insurance Comparison Charts • CUSHIP and NY Exchange Plans • Comparison of Quality and Price • SHIP Premium $184.33 per month • Bronze Exchange Plan $252 per month • CUSHIP and CU Employee Plans • Comparison of Quality – Educate Internal Stakeholders ( eg. Graduate School)

  35. Essential Benefit Comparison: Cornell University SHIP & NY Exchange Plans

  36. Essential Benefit Comparison: Cornell University SHIP & NY Exchange Plans

  37. Plan Premium Comparison: Cornell University SHIP & NY Exchange Plans

  38. Essential Benefit Comparison: Cornell Program for Healthy Living and SHIP Student Plan Employee Plan

  39. Post ACA - Strategies Summary • International Students • Required to be on CUSHIP • Improves health and safety and access to care • SHIP in lieu of Medicaid • Win/Win – improves access to care and saves NYS money and CU financial aid grant money • Self Funding the SHIP • Will help to reduce overhead costs, lower taxes and fees, and stabilize prices.

  40. ACA Taxes and Fees • Impact on Premium • 3 to 5% which is significant as SHIPs are low cost • Not all apply to Self Funded Plans • Consult with your Insurance Carrier and Legal Counsel

  41. University of Minnesota (UMN) • Twin Cities Campus plus • 4 system campuses across Minnesota (Duluth, Crookston, Morris, Rochester) • 68,047 students • 43,646 Undergraduate • 13,606 Graduate • 4,194 Professional • 6,601 Non-degree

  42. Institutional Requirement • Students enrolled in a degree seeking program taking 6 or more credits that count toward payment of Student Service Fees (on campus credits) • International students and scholars and dependents are required to enroll in the plan • Students are required to provide verifiable insurance information during class registration to waive enrollment in the SHBP

  43. Eligibility and Enrollment48,000 SHBP Eligible Students • 9,465 or 19.7% of eligible students enrolled in the SHBP • 169 Spouse/Domestic partner • 395 Children • 4,500 or 9.4% enrolled in the GA Plan • February 2014 Survey reflected 8.3% of eligible students still report being uninsured • 4.3% undergrad students • 15.8% of grad & professional students

  44. UMN Student Health Benefit Plan • ACA compliant • 2013-14 premium: $1,998 • 90.06% Actuarial Value (Platinum level plan) • No Deductible • 80% coverage with $3,000 OOP max • Utilizing worldwide network • Medical Evacuation/Travel Assistance • $15,000 AD&D coverage

  45. WHY Consider Self Funding • We had the institutional mandate (since 1975) • We were legally able • Achieved successful cost containment • Capitated services at Boynton for medical & pharmacy • Careful administration and contract strategies - beneficial risk agreements • Good claims experience • We were able to build reserves

  46. WHY Consider Self Funding • We wanted to remove the Pre-existing condition limitation that currently existed • We wanted to achieve premium stabilization • We had the ability to manage resources at BHS to administer the plan • Knowing our fiduciary responsibility to focus on the best interests of the students • A beneficial time to explore

  47. The Road to Self Funding 2000-2001 Request for Proposal • Bid both fully insured and self funded • Compared cost and benefits • Developed a partially self funded Program • Students would only pay for claims they use • Eliminated the pre-existing condition exclusion • Cost increase 1.1% ($906 to $916/yr)

  48. RESULTS We’ve been able to have the flexibility to: • Expand the health plan to all campuses (Taking into consideration the health service models) • Create a health plan for AHC students specific to their needs • Easily make benefit enhancements to the plan • Benefit from years with good claims experience • Avoid state premium taxes assessed to fully insured plans • Fund reserves for premium stabilization and unexpected expenses. • Benefit from marketplace competition • 2007 RFP: reduction of TPA admin and reinsurance cost by 35%, saving students $5 million over 6 year contract

  49. RESULTS Rate action for 5 years • 2010 - 2011 - 2.54% increase • 2011 - 2012 - 2.15% increase • removed preventive care maximums and added immunizations benefits • 2012 - 2013 - 0% increase • Instituted hard waiver – projection enrollment gain, no cost increase, reduction in the cost of coverage for dependents. Added coverage for contraceptive benefits and gender reassignment (cap $35K) • 2013- 2014 – 4.72% increase to $999/semester; $1998 annual • Removal of the lifetime maximum medical benefit limit • Preventive care coverage increase from 80% to 100% of eligible expenses • Contraceptive coverage increase from 80% to 100% of eligible expenses • Dependents now eligible until age 26 • Removal of the annual maximum on prescription benefits Prescription drug copays will change to $15.00 generic, $25.00 brand name • 2014 - 2015 – 5.1% increase to $1049/semester; $2098 annual

More Related