Student Health Insurance Plan Discussion Phyllis M. Lombardi Business Operations Manager University Health Services

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1 Student Health Insurance Plan Discussion Phyllis M. Lombardi Business Operations Manager University Health Services

2 Agenda Dependent Rate Parity Effect on Student Health Insurance Plan (SHIP) Rates Aetna Renewal Rates Suggested Plan Change for Market Place Platinum Plans Peer Institutions and Local Universities Questions

3 What is Dependent Rate Parity? Beginning with the Policy Year, rates for dependents are required to be the same as for their related student. This methodology has recently been required in a number of states (6) and by other institutions of higher learning. Aetna (along with most major insurance carriers) is adopting this approach in all markets.

4 Standard vs. Enhanced Standard $400 annual deductible After deductible is met, insurance pays 80%, you pay 20% coinsurance, up to the out of pocket maximum $3,500 out of pocket maximum Enhanced $0 annual deductible No coinsurance. Every visit has a preset copay, varying from $0 for mental health outpatient to $150 for inpatient admission. $3,000 out of pocket maximum, however, it is difficult to reach 12 ER visits ($900), 12 inpatient admissions ($1,800), 10 doctor/specialist visits ($200), 5 blood work/x-ray/mri ($100)

5 Effect on SHIP Rates Current Rates (w/o rate parity) Standard Plan: Student Only $1,156 Student + 1 $3,178 (Student Rate x 2.75) Student +2 $3,835 (Student Rate x 3.32) Enhanced Plan: Student Only $2,461 Student + 1 $6,902 (Student Rate x 2.81) Student +2 $8,403 (Student Rate x 3.41) Current Rates (w/ rate parity) Standard Plan: Student Only $1,156 Student + 1 $2,312 (Student Rate x 2) Student +2 $3,468 (Student Rate x 3) Student +3 New Tier $4,624 (Student Rate x 4) Enhanced Plan: Student Only $2,461 Student + 1 $4,922 (Student Rate x 2) Student +2 $7,383 (Standard rate x 3) Student +3 New Tier $9,844 (Standard rate x 4)

6 What does this mean? Using numbers from the current year: 157 families would see a decrease in the cost of a two person plan 33 families would be affected by a fourth tier The cost for dependent coverage can no longer be allocated to the students who enroll in dependent coverage. This puts the cost of subsidizing dependents on the individual students. For , we were able to negotiate and maintain only three tiers, but this will change for the academic year.

7 Aetna Renewal Rates with Dependent Rate Parity Standard Plan (administrative fee not included) Student Only = $1,307 (13.1 % increase) Student plus One Dependent = $2,614 (21.6% decrease) Student plus Two or More Dependents = $3,921 (2.2% increase) Enhanced Plan (administrative fee not included) Student Only = $2,830 (15% increase) Student plus One Dependent = $5,660 (18% decrease) Student plus Two or More Dependents = $8,490 (1% increase)

8 Aetna Renewal Rates with Dependent Rate Parity Due to the % increase in premiums from dependent rate parity, we also requested rates if we were to only offer one plan for : Standard Plan only offered (administrative fee not included): Student: $1,377 (5% increase over 2 plan rate) Student + 1 dependent: $2,754 Student + 2 or more dependents: $4,131 Enhanced Plan only offered (administrative fee not included): Student: $1,583 (44% DECREASE over 2 plan rate) Student + 1 dependent: $3,166 Student + 2 or more dependents: $4,749

9 Suggested Plan Change for Discussion Point: Consider offering only the Enhanced Plan beginning Benefits: Platinum level plan with no deductible and no coinsurance First dollar coverage Students know exact $$ they are going to be responsible for: Mental health, substance abuse and physical therapy outpatient visits have $0 copay. Inpatient stays have $150 copay per admission. Doctor and specialists have a $20 copay. Lab work, x-rays, MRI s have a $20 copay Cost of insurance is a cost of education and is used in financial aid calculation. Deductible and co-insurance are not.

10 Suggested Plan Change for Why Enhanced vs. Standard: The Standard plan has a $400 deductible and a $3,500 out of pocket maximum. These costs still prevent a barrier to care. With $0 copay for mental health outpatient visits, students are more likely to get care sooner. The difference in the cost between the Standard Plan ($1,307) and the Enhanced Plan ($1,583) is $276. One emergency room or specialist visit per plan year on the Standard plan would cost more than that.

11 Example: Outside Lab Work $ 250 discounted price using Aetna Network Provider Standard Plan: $1,307 premium 250 towards annual deductible $1,557 total Enhanced Plan: $1,583 premium 20 copay $1,603 total

12 Example: Emergency Room Visit $1,250 discounted price using Aetna Network Provider (not admitted) Standard Plan: $1,307 premium 400 annual deductible 100 ER copay (20% of $ after deductible & copay) $1,957 total Enhanced Plan: $1,583 premium 75 ER copay $1,658 total

13 Example: MRI $900 discounted price using Aetna Network Provider Standard Plan: $1,307 premium 400 annual deductible (20% of $ after deductible) $ 1,807 total Enhanced Plan: $1,583 premium 20 MRI co-pay $1,603 total

14 Actual (March 2015): Emergency Room Visit with Inpatient Admission and Surgery $34,251 discounted price using Aetna Network Provider Standard Plan: $1,307 premium 400 annual deductible (20% of $33,851 after deductible, limited to $3,500 out of pocket 3,100 maximum) $ 4,807 total Enhanced Plan: $1,583 premium 150 inpatient copay $1,733 total

15 Gold Marketplace Plans for Pittsburgh Area Gold Plans as of March 2015 Premium Deductible Out of Pocket Maximun UPMC Advantage Gold $500/$15 Partner Network $1,284 $500 $3,000 UPMC Advantage Gold $750/$10 Partner Network $1,284 $750 $3,000 United Healthcare Gold Compass 500 $1,308 $500 $6,600 Highmark Shared Cost Blue PPO 1200 Community Blue Flex $1,344 $1,200 $3,700 Highmark Total Health Blue PPO 1200 Community Blue $1,356 $1,200 $3,000 UPMC Advantage Gold $500/$15 Select Network $1,356 $500 $3,000 UPMC Advantage Gold $750/$10 Select Network $1,356 $750 $3,000 Highmark Balance Blue PPO 500 Community Blue $1,440 $500 $2,400 UPMC Advantage Gold $500/$15 Premium Network $1,584 $500 $3,000 UPMC Advantage Gold $750/$10 Premium Network $1,584 $750 $3,000 Coventry Gold $5 Copay HMO $1,824 $1,400 $5,000 Highmark Shared Cost 1500 $1,956 $1,500 $4,000 Highmark Shared Cost Blue PPO 1500 $1,956 $1,500 $4,000 Highmark Health Savings Blue PPO 1300 $1,992 $1,300 $2,300 Assurant Health Gold Plan 002 $2,244 $0 $6,350

16 Platinum Marketplace Plans for Pittsburgh Area Platinum Plans (as of March 2015) Premium Deductible UPMC Advantage Platinum-Partner Network $3,420 $250 UPMC Advantage Platinum- Select Network $3,600 $250 Highmark Comprehensive Care Blue PPO 500 $3,744 $500 Assurant Health Platinum Plan 002 $4,032 $0 UPMC Advantage Platinum-Premium Network $4,140 $0

17 Peer Institutions and Local Universities Institution Premium # of Plans Standard (S) or Enhanced (E) Equivalent Deductible Out of Pocket Maximum Carnegie Mellon University*** $1,618 E $0 (in network) $3,000 PEER INSTITUTIONS Georgia Insitute of Technology* $1,308 1 S $250 (in network) $3,750 Princeton* $1,900 1 S $200 $5,000 Duke University* $2,100 1 S $0 (in network) $2,000 Rice University* $2,109 1 S $250 (in network) $3,000 MIT* $2,268 1 E $0 (in network) $4,000 Cornell * $2,352 1 E $0 (in network) $3,000 Emory University* $2,850 1 E/S $250 (in network) $6,350 University of Pennsylvania* $3,140 1 E $300 (in network) $900 Northwestern* $3,449 1 S $250 $1,800 Stanford University* $4,296 1 S $200 (in network) $3,000 LOCAL UNIVERSITIES Point Park University* $1,578 1 S $350 (in network) $6,350 Duquesne University* $1,767 1 S $500 (in network) $2,500 Robert Morris University* $1,836 1 S/E $100 (in network) $6,350 $2470 (undergrad) University of Pittsburgh* $4132 (grad w/o academic appt) 1 E $0 (in network) $3,500 Penn State University* $2,838 1 S/E $250 $1,350 * Rate for *** Proposed rate and plan for and estimated admin fee of $35. Ending SHIP as of

18 Peer Institutions and Local Universities Inpatient (Including Mental Health), per admission Radiology (MRI, CT, xrays) Physical, Speech &/or Occupational Therapy Institution Premium Office Visits/ Specialists Mental Health (Out Patient) Emergency Room Lab Work Carnegie Mellon University*** $1,618 $20 $0 $150 $75 (waived if admitted) $20 $20 $0 PEER INSTITUTIONS Georgia Insitute of Technology* $1,308 $25/$40 20% 20% $50 (waived if admitted), 10% 20% 20% $25 Princeton* $1,900 $10 0% 20% 20% $0 20% 20% Duke University* $2,100 $25/$35 $25 20% $150 copay, 20% 20% 20% 20% Rice University* $2,109 $20, 25% 25% 25% $150 (waived if admitted), 25% 25% 25% 25% $0 for visits 1-12, MIT* $2,268 $25 $25 visit 13 on $100 $50 (waived if admitted) $0 $50 $25 Cornell * $2,352 $25 $10 $250 $75 (waived if admitted) $0 $0 $25 Emory University* $2,850 $25 $10 10% $50 (waived if admitted) 10% 10% $25 University of Pennsylvania* $3,140 $30 $30 $100 $100 (waived if admitted) $35 $50 10% Northwestern* $3,449 $20, 20% $25 20% 20% $20, 20% $20, 20% $20, 20% Stanford University* $4,296 20% $20 20%, mental health 0% $75 (waived if admitted) 20% 20% $40 LOCAL UNIVERSITIES Point Park University* $1,578 20% 20% 20% $100 (waived if admitted) 20% 20% 20% Duquesne University* $1,767 $25 20% 20% $75 (waived if admitted) 20% 20% $20 Robert Morris University* $1,836 $20 $20 $250,10% $100 (waived if admitted) 10% 10% $20 University of Pittsburgh* $2470 (undergrad) $4132 (grad w/o academic appt) $10/$25 $25 $250 $75 (waived if admitted) $0 $0 $25 Penn State University* $2,838 10% 10% 10% $150 (waived if admitted), 10% 10% 10% 10% * Rate for *** Proposed rate and plan for and estimated admin fee of $35. Ending SHIP as of

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