Transcript Fall NICCIA Meet

Jeff Crawford, Vice President
[email protected]
Ph: 800-821-7715, Ext. 148
Monica Olson, M.Ed., Regional Sales Director
[email protected]
Ph: 206-618-8337
Shifting Sands Ahead
Brainstorm a short list of what is valuable, important
or necessary in an insurance plan.
What is important to you, your staff or yourself
when you think about using or administering
an international student insurance plan?
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PPACA: Patient Protection and Affordable Care Act
ACHA: American College Health Association
Deductible: Small amount of money paid out of
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pocket for each sickness or injury
Co-pay: Small set amount of money paid out of
pocket for each office or hospital visit
Co-Insurance: a certain set percentage of money
to be paid for each service
SHP: Student Health Plan
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MLR: Medical Loss Ratio
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March 23, 2010:
Affordable Care Act was signed into law
March 21, 2012:
Final regulations on student health insurance
plans
June 28, 2012:
United States Supreme Court upheld the
constitutionality of most of PPACA
For plan years beginning July 2012-September 2012:
Annual coverage limits of no less than $100,000
For plan years beginning September 2012-December
2013: Annual coverage limits of no less than
$500,000
For plan years beginning January 2014:
No annual limits
PPACA requires all compliant student health plans
(SHPs) to have:
◦ Preventative Care: Student health coverage is
required to provide preventive services without
cost-sharing and co-pays.
◦ Pre-existing Condition Limitations: Plans may not
impose pre-existing condition limitations on those
younger than age 19.
As of 2014, pre-existing conditions cannot be excluded.
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Individual Mandate - January 1, 2014
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Essential Health Benefits: must include these 10
categories
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Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Pediatric services, including oral and vision care
Mental health and substance use disorder services,
including behavioral health treatment
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services, chronic disease
management, and prescription drugs
Waivers
Examine waiver policy to close the gap for
waivers and keep your risk exposure low
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Cost-Benefit
You want enhanced benefits, but there is a
tipping point for cost and use…where is it?
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2014 Policy Year and Beyond: PPACA Plans
 Unlimited Coverage
 No Exclusion for Pre-Existing Conditions
 MLR – 80% (Medical Loss Ratio)
 Cost Increase and Destabilization
Current
Premium
Claims
PPACA
$100,000
$75,000
Premium
Claims
$120,000
$90,000
Loss Ratio (LR)
75%
Loss Ratio (LR)
75%
Target
70%
Target
80%
Potential Refund
$0
Potential Refund
5%
 Unlimited Coverage
 Current Accident &
Sickness Coverage
 $250 Deductible
 $0 Deductible
 20% Coinsurance
 100% Network Coverage
 No Pre-existing Exclusion
 Pre-existing Exclusion
 Wellness Coverage
 Limited Wellness
Coverage
 Increased $$ Premium
Plan A
 Stable Premium
Plan B
Policy Year: 2013-2014
 Compliant Plan
• Participation mandate important
• Benefits include wellness and immunizations
 Other Options
•
Limited Duration:
Accident and Sickness Only Plan
Now that you have learned about the
upcoming PPACA changes…
What is important to you, your staff or
yourself when you think about using or
administering an international student
insurance plan?
http://www.healthcare.gov/law/full/patientprotection.pdf
Affordable Care Act
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http://acha.org/Topics/Affordable_Care_Act/Aff
ordableCareAct.cfm
ACHA Website
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http://www.healthcare.gov/news/factsheets/201
0/09/affordable-care-act-immunization.html
ACHA Immunization List
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