Student Health Insurance

Anita Barkin

November 21, 2002

Current Program

• Voluntary program

• Three options for coverage

Strengths

• Rich in benefits

• Enrollment of over 2000 due to strong marketing effort

• GSA support for the program

Weaknesses

• Adverse selection

• Substantial increases in premiums– high loss ratios– changes in the student insurance market

• Uninsured and underinsured graduate students and international students

Changes in the Market

• Fewer carriers are in the student insurance market

• Fewer carriers are submitting proposals for voluntary programs

• Student plans are experiencing cost increases in four areas: outpatient, inpatient, prescription drugs and physician services

(Cronin, 2002)

Benchmarks

• Survey of top 25 schools– 18 have a mandatory/hard waiver program for all students

– 2 have a mandatory/no waiver program for all students

– 1 has a mandatory/hard waiver for undergrads and a mandatory/no waiver program for grads and international students

– 2 have a mandatory/hard waiver for some populations

– 2 do not have a mandatory program

Schools with Mandatory Programs

• Ten of the eighteen mandatory/hard waiver programs also require that the private insurance meet certain minimum standards in order to qualify for the waiver

Recommendation

• Adopt a mandatory/hard waiver insurance policy for all enrolled full-time students, effective Fall 2003

• Change insurance plan to two options

Rationale• Supports student retention

– Individuals who are uninsured or experience a change in their insurance are less likely to seek care for illness/injury in a timely manner or use preventive services (Smith, 2001)

– Protects students from significant medical expenses that can impact financial stability and the ability to continue one’s education

• Protects the public health of the campus community and reduces risk to the university

• Reduces risk of adverse selection– Potential reduction in premium of 19% +/- 4%

Implementation

• The charge for the basic mandatory plan will be placed on the student’s Fall invoice

• Students will be required to present proof of insurance in order to have the charge removed by the end of the open enrollment period

• Students can upgrade their plan within the open enrollment period

Requirements for Waiver

Documentation of coverage as the dependent, partner/spouse, or principle in

an employer or government sponsored group benefit program that meets

accepted minimal standards

Immunization Requirements

Current protocol

• All undergraduate students must have either two doses of measles vaccine, demonstrate immunity or apply for religious or medical exemption

• All undergraduate international students must have a TB skin test within one year of arrival

• Graduate students are not monitored for compliance

Enforcement

• 100% compliance for measles vaccination in first year population– Residential privileges are withheld– Hold on Spring registration

Senate Bill 955

• Requires all students living in residence halls be vaccinated against meningitis or sign a waiver

• Signed into law June 28, 2002– effective August 29, 2002

Weakness of current protocol

• Process is labor intense and inefficient

• Does not provide adequate protection for the campus community against vaccine preventable infection– Outbreak of a contagious disease that can be very

costly to an institution and have a significant impact on university activities

Benchmarks

• 15 schools surveyed– 14 have a prematriculation immunization

requirement for both graduate and undergraduate students

• 14 require MMR (measles, mumps, rubella)

• 3 recommend Hepatitis B, 3 require it for all students, 5 for health professions

– 1 does not have immunization requirements

Recommendation

• Adopt a mandatory prematriculation immunization requirement consistent with Pennsylvania State Department of Health recommendations for all incoming full-time students effective Fall 2003

Vaccine requirement

• All full time students– Two doses of measles vaccine– One dose of rubella and mumps

• All students residing in university housing– Hepatitis B vaccination series– Meningitis vaccination

• Tuberculin skin testing for all international students

Exceptions

Waivers for religious and medical reasons

Waiver from TB skin testing based on country of origin

Enforcement

• Impose a $50 penalty for noncompliance by first day of class in August

• Place a hold on Fall registration

Premium HistoryOPTION 1 2000-2001 2001-2002 2002-2003Individual 961$ 1,112$ 1,692$ Two person 2,377$ 2,756$ 4,208$ Family 2,708$ 3,140$ 5,047$

OPTION IIIndividual 718$ 830$ 1,293$ Two Person 1,771$ 2,053$ 3,274$ Family 2,017$ 2,339$ 3,875$

OPTION IIIIndividual 511$ 589$ 767$ Two person 1,254$ 1,452$ 1,966$ Family 1,427$ 1,653$ 2,359$

Undergraduate Enrollmentin Student Health Insurance

Fall 1999 Fall 2000 Fall 2001

568 618 612

Grad Student Enrollment

Fall Ō99 Fall Ō00 Fall Ō01Masters PhD Masters PhD Masters PhD

Total Enrollmentin Student HealthInsurance

1032 883 1061 840 977 846

Total EnrolledGraduates 2177 1066 2218 1143 2361 1187

Utilization byClass 47.1% 82.8% 47.8% 73.5% 41.4% 71.3%