SOUTH DAKOTA BOARD OF REGENTS. Full Board ******************************************************************************

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1 SOUTH DAKOTA BOARD OF REGENTS Full Board REVISED AGENDA ITEM: 13 DATE: June 11-12, 2014 ****************************************************************************** Subject: Study Abroad Insurance, Foreign National Inbound Medical Evacuation and Repatriation, and Student Health Insurance Study Abroad Insurance (See Attachment I) BOR Policy 3:14 requires students, staff and faculty to be insured while studying abroad or representing their university abroad. In FY14 an RFP was issued to ensure the rates and coverage level for study abroad insurance for our students, faculty and staff was competitive. After reviewing five proposals, it was determined to renew the current vendor, Cultural Insurance Services International (CISI). Additionally, in January 2014 daily rates became available for faculty, staff and their dependents, making the coverage more cost effective for faculty and staff who typically travel for shorter periods of time. The rates from FY14 to FY15 have no increases; therefore, the premiums will remain the same. Attachment I provides a detail of the travel insurance. CISI Premium Renewal FY15 FY14 FY15 Participant Type Monthly Monthly Students Spouse of Student Child of Student Faculty Staff 1.45/day 1.45/day Spouse of faculty/staff 2.24/day 2.24/day Child of faculty/staff 1.92/day 1.92/day (Continued) ****************************************************************************** RECOMMENDED ACTION OF THE EXECUTIVE DIRECTOR Approve the Study Abroad CISI Insurance and Inbound CISI Insurance. Require international students to produce evidence of health insurance coverage prior to enrollment. A record of such evidence is to be kept at each institution. Authorize the Executive Director to develop a communication plan to inform students that the Board of Regents will no longer offer a student health plan and inform them of options for health plans under the Affordable Care Act.

2 Study Abroad Insurance, Foreign National Inbound Medical Evacuation and Repatriation, and Student Health Insurance June 11-12, 2014 Page 3 of 7 Foreign National Inbound Medical Evacuation and Repatriation (See Attachment II) Over the past several years, there has been an increase in the number of J1/J2 status employees, students, and/or scholars who are required by federal regulation to have insurance coverage for medical evacuation and repatriation of remains. Many national health plans do not cover medical evacuation and repatriation so our employees/scholars have had to purchase a secondary insurance plan to accommodate the federal regulations. This coverage has been provided as an add-on feature with our study abroad insurance vendor. Through the RFP process, Cultural Insurance Services International (CISI) was also renewed as the provider for the add-on coverage. This add-on feature covers all inbound foreign students and scholars for medical evacuation and repatriation to supplement their primary insurance. Attachment II provides detail on the insurance. The rates from FY14 to FY15 have no increases; therefore, the premiums will remain the same. CISI Premium Renewal FY14 FY14 FY15 Participant Type Monthly Monthly Students, Faculty and Staff Spouse Child Student Health Insurance (See Attachment III) Ms. Kayla Bastian has been working with Avera Health Plans (AHP) on the renewal rates for the student health plan. Due to the Affordable Care Act (ACA) there are requirements to make additional enhancements to the SDBOR Student Health Insurance. The two major design changes to the current plan are the removal of the $500,000 annual maximum and the addition of a $6,350 out-of-pocket maximum. ACA has required the student health plan to move from a sickness and injury plan to a more comprehensive major medical insurance plan. From a historical perspective, this plan originated as a sickness and injury plan with a maximum of $50,000. Attachment III provides information regarding plan premium and claims history. There are several concerns about the sustainability of continuing to offer the current student health insurance plan. The tentative premiums proposed by Avera Health Plans (AHP) result in a significant increase, the primary age group of the plan would see over a 60% increase from last years rates. In addition, the classification of the student health plan by the division of insurance requires that age ratios are used to determine premiums, resulting in a substantial increase to premiums after age 20. The universities have expressed significant concern about their ability to recruit and retain international students if we require them to purchase this high cost insurance plan. International students are the only students who are required by BOR policy to participate in the student health plan. In addition, this subset of students is not required to be enrolled in an ACA

3 Study Abroad Insurance, Foreign National Inbound Medical Evacuation and Repatriation, and Student Health Insurance June 11-12, 2014 Page 3 of 7 compliant healthcare plan, unless they have been in the United States for more than five years, for F1 students and two years for J1 status. The landscape of healthcare has drastically changed due to ACA and it is time to consider no longer offering and administering a student health plan. There are now many insurance options for domestic students with the implementation of the exchanges, coverage is easier and possibly more affordable for them to obtain and subsidies are available to students who meet income requirements. In addition, the health insurance requirements for domestic students are no longer the same as they are for international students. Continuing with the current plan forces international students into an ACA compliant plan that has become cost prohibitive to them. The current student health plan population is made up primarily of international students, approximately 70% of enrollees are international students. If a student health plan is no longer offered through SDBOR, there will need to be processes implemented to ensure that international students are insured to remain in compliance with federal regulations and BOR Policy By policy, international students must provide evidence of credible U.S. health insurance coverage. A policy change to revise the requirement for utilizing the SDBOR sponsored health plan will be brought before the Board in August The policy will include a clear provision that institutions have a documented and auditable process. An audit will be scheduled for April 2015 to review campus documentation. A clear communication plan will be developed with the universities in order to inform students who are currently on the health insurance plan (and those who are coming into our system) how to gain coverage from the federal exchange. In addition, international students will be provided information on how to gain coverage that meets federal visa requirements and, if necessary, ACA compliance.

4 ATTACHMENT I 4 Policy Number: GLM N Underwritten by ACE American Insurance Company, a member of The ACE Group of Companies Name of Sponsoring Organization: South Dakota Board of Regents Address: 306 E Capital Ave, Suite 200 City: Pierre State: SD Zip Code: Group to be Insured: Study/Volunteer/Intern/Exchange Abroad Program Participants & Faculty/Staff Involved in International Education Activities Estimated Number of Participants Per Year: 400 Dependents: -yes- Effective Date of Policy: 9 (Month) 01 (Day) 14 (Year) Schedule of Benefits Accidental Death & Dismemberment $15,000 Medical Expense (per Accident or Sickness): 100% Deductible $-0- (zero) Dental Treatment (Injury Only): Accidental Dental, up to policy Emergency (Palliative) Dental: $500 maximum Pre-existing Conditions Coverage Limit Up to $2,500 Mental and Nervous (Outpatient/Inpatient): Up to $1,000 outpatient/$5,000 inpatient Physiotherapy: If recommended by a Physician and administered by a licensed physiotherapist Specified Therapies and Spinal Manipulation (Outpatient Limit): Termination of Pregnancy Maximum of $100/visit; maximum of 10 visits; $1,000 overall $500 Prescription Drugs (Inpatient/Outpatient) 100% of Usual and Customary Charges Home Country Coverage $10,000 Benefit Maximum(secondary basis) Extension of Benefits Up to 30 days Limit for: Emergency Medical Evacuation Repatriation/Return of Mortal Remains Emergency Medical Reunion $3,000, $150 maximum per day Lost Luggage/Personal Effects Up to $250 24/7/365 Team Assist Package Included Comprehensive Security Evacuation $100,000 Trip Interruption Coverage $2,500 *Coverage for Named Activities Up to $10,000 Limited Coverage for injury sustained while taking part in mountaineering; hang gliding, parachuting, bungee jumping; racing by horse, motor vehicle or motorcycle; parasailing Program Fee Refund Coverage $2,500 Travel Delay Benefit $500 ($100/day) * Otherwise excluded

5 ATTACHMENT I 5 Premium Schedule Term: Paid at beginning of program Age Rated: Yes No x Participant Type Remarks: Student Spouse of Student Child of Student Faculty/Staff Spouse of Faculty/Staff Child of Faculty/Staff $36.90/month $56.90/month $48.90/month $1.45/day $2.24/day $1.92/day 1) Coverage is primary while abroad 2) Nervous/mental conditions covered up to $1,000-outpatient/$5,000-inpatient (option #1A) or $2,500-outpatient/$10,000-inpatient (option #1B) 3) 30-day extension of benefits for conditions first treated while covered overseas 4) $10,000 in home country coverage (secondary to domestic insurance) 5) Expenses resulting from alcohol and drugs covered 6) Pre-existing conditions covered up to $1,000 (option #1A) or $2,500 (option #1B) 7) Accidental Dental repair or replacement to natural teeth damaged as a result of a covered Accident covered up to the Medical Expense limit 8) Emergency (or Palliative) Dental emergency pain relief to natural teeth covered up to $500 (maximum of $250/tooth) 9) Maternity covered 10) Suicide & Self-Inflicted injuries covered with the exception of Accidental Death & Dismemberment 11) Any insured planning to travel to Cuba or Antarctica will be required to fill out a brief form (provided to SDBOR by CISI prior to policy effective date). The form will need to be submitted to CISI prior to departure. Date Accepted By (Signature for Sponsoring Organization) Printed Name/Title Complete and scan/ or fax to: Cultural Insurance Services International c/o Emily Davis edavis@culturalinsurance.com Fax: Phone: Fax:

6 ATTACHMENT II 6 Policy Number: GLM N ( Int l Student Evac -Only) Underwritten by ACE American Insurance Company, a member of The ACE Group of Companies Renewal Summary Name of Sponsoring Organization: South Dakota Board of Regents Address: 306 E Capital Ave, Suite 200 City: Pierre State: SD Zip Code: Tel: (605) Fax: (605) kayla.bastian@sdbor.edu Group to be Insured: Inbound International Students and Scholars (F-1, J-1, and M-1 visa holders) and eligible dependents Estimated Number of Participants Per Year: 300 Dependents: -yes- Effective Date of Addendum: 9 (Month) 01 (Day) 14 (Year) Limit for: Emergency Medical Evacuation Repatriation/Return of Mortal Remains Schedule of Benefits Term: Paid at beginning of program Age Rated: Yes No x Remarks: Premium Schedule Participant Type Monthly International Students and Scholars $6.00 -Spouse- $9.00 -Child- $8.00 1) Refer to full policy for exclusions and limitations. Date Accepted By (Signature for Sponsoring Organization) Printed Name/Title Complete and scan/ or fax to: Cultural Insurance Services International c/o Emily Davis edavis@culturalinsurance.com Fax: Phone: Fax:

7 ATTACHMENT III 7