shiac insurance 101

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ppt presentation From University Health Services (UHS) at UC Berkeley regarding student health insurance


  • SHIAC MeetingInsurance 101

    October 23, 2015

  • SHIP 101 Glossary Medical, Dental, and Vision Benefits

    History of SHIP Self-Funded vs. Fully funded.

    Enrollment Statistics Universitys Guiding Principles for SHIP Renewal SHIACs Guiding Principles for SHIP Renewal

    Insurance 101 Agenda

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

    EXAMPLE: Berkeley SHIPs 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 services Berkeley 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

  • Universitys 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