SHIAC MeetingInsurance 101

October 23, 2015

• SHIP 101– Glossary– Medical, Dental, and Vision Benefits 

• History of SHIP– Self-Funded vs. Fully funded.

• Enrollment Statistics• University’s Guiding Principles for SHIP Renewal• SHIAC’s Guiding Principles for SHIP Renewal

 

Insurance 101 Agenda

Glossary • Premium – The amount you pay to be enrolled in insurance plan

– EXAMPLE: Berkeley SHIP’s undergrad premium is $1290/semester

• Co-insurance – The percentage of the health care costs you have to pay.

– EXAMPLE: For some services, Berkeley SHIP pays 90%, and you pay 10%

• Deductible– The amount of medical costs you have to pay before your

insurance kicks in – per year. – EXAMPLE: Berkeley SHIP has a $300 annual deductible for some services outside of Tang

• Co-pay – An upfront cost you pay when you have an office visit; Not counted as

part of deductibles. – EXAMPLE: Primary Care visits at Tang are $15

ALL students have access to University Health Services

~60% of students have SHIP

• All UC Students* are:– Required to have major medical health insurance

– Automatically enrolled in SHIP when registered (current SHIP coverage August 15,2015-August 14,2016)

– Able to enroll in SHIP any time within the semester if their current coverage is lost (no prorated rate)

– Able to maintain dual coverage

– Able to waive out of the plan through an online waiver

* With some exceptions e.g. extension students

Insurance at UC Berkeley

• Medical and mental health plan through Aetna Student Health (ASH)

• Dental plan through MetLife

• Vision plan through Vision Service Plan (VSP)

Plan Carriers

Student Health

ACA “Essential Health Benefits”:• preventive and wellness services and chronic disease

management

• mental health and substance abuse disorder services, including behavioral health treatment

• rehabilitative and habilitative services and devices

• ambulatory patient services

• emergency services

• hospitalization

• maternity and newborn care

• prescription drugs

• laboratory servicesBerkeley SHIP

already provided

all of these benefits plus

includes dental and vision

Based on in-network providers

SHIP BENEFIT HIGHLIGHTSPreventative 100% covered (you pay $0)

Primary Care $15 co-pay

Specialists $15 co-pay

Urgent Care $30 at UHS; $50 outside UHS

Counseling Outside UHS $15 co-pay (first five visits free at UHS for all students)

Emergency Room $100 co-pay

Hospitalization 90% co-insurance (you pay 10%)

Labs/tests/x-rays 90% co-insurance (you pay 10%)

Prescription drugs $5 generic, $25 brand name

Dental 2 free cleanings/exams per year; 80% co-insurance minor dental, 70% co-insurance coverage major dental (up to $1000/year)

Vision $10 eye exam, $25 co-pay frames & lenses, or contact lenses (up to $120/year)

Deductible $300 for some services outside of Tang

Medical Benefits Overview● You pay 10% in-network, 40% out-of-network

○ Except for emergency or urgent care, referrals are required for ALL services received outside the Tang Center

● $3200 Out of Pocket Maximum for in-network services ($6500 out of network per plan year)

● No Lifetime Maximum● National network

• 24/7 Nurseline through Sirona

• On Call International provides worldwide medical assistance and information– Includes Evac and Repatriation benefits

Additional Benefits

2015-2016 Premiums

UG: $1,290/semester

Grad: $1,877/semester

• 1987 Graduate students approve a new fee for Graduate Student Health Insurance Plan.

• 1990: Students approve a new fee for Undergraduate Student Health Insurance Plan.

• Regental mandate that all qualified students enrolled in UC are required to carry health insurance.

• 1987-Spring 2011: SHIP insurance provided by Anthem as a self-funded plan

SHIP History

• Fall 2011-Spring 2013 - Berkeley and all UCs join UC SHIP, provided by Anthem (self-funded)• Voluntary dependent plan added

• Fall 2013: UC Berkeley Chancellor withdraws from UC SHIP following $60M deficit in UC SHIP and with recommendation of student govt.

• Berkeley SHIP is created, provided by Aetna Student Health as a fully-funded plan

• 3.5 other UC campuses leave UC SHIP too.• January 2014: Affordable Care Act (ACA)

SHIP History

• This is about who takes on financial risk if medical claims costs are too high compared to premiums

• Self-funded plan• Plan administrator (University) takes risk • ASO fees to carrier

• Fully-funded plan• Insurance carrier takes on risk• Pay additional taxes and fees to government

• Different ACA rules apply to self vs. fully funded plans

Self- vs. Fully-funded plan

• Undergraduate Students ~ 14,000

• Graduate Students ~ 8,000

• Voluntary Filing Fee Graduate or Concurrent Undergraduate ~ 25

• This Fall, about 17,200 waivers submitted

• Over 15,900 successfully waived out

• Word of caution: We audit 25% of waived accounts. If fail audit, placed back on SHIP without proration

Fall 2015 Enrollment

• University’s Guiding Principles for Renewal:– ACA Compliant– Affordability (premiums and out of pocket costs)– Comprehensive benefits– Financially healthy plan– Vast provider network– Responsive and helpful Account Team– Local control over plan management– Limited and customized subsidization, esp for other

campuses– Reliable and friendly customer service– Accurate and timely data reporting

Guiding Principles