2023 State of the Union | Employee Benefits and the Workplace

President Biden Discusses Employee Benefits and the Workplace in State of the Union Address

On Tuesday, Feb. 7, President Joe Biden delivered the 2023 State of the Union (SOTU) address. The SOTU address is an annual speech the president delivers near the beginning of each year, outlining how the country is doing and identifying future initiatives the current administration wants to pursue. For employers, the SOTU address is important as it often provides insight into proposed plans and initiatives relevant to the workplace. The 2023 SOTU address focused on health care and the economy. Read on for the main takeaways from the speech.

“Let’s also make sure working parents can afford to raise a family with sick days, paid family and medical leave, and affordable child care that will enable millions more people to go to work.”
– President Biden, in the SOTU address

Workplace Changes

President Biden pushed for passing the Protecting the Right to Organize Act (or PRO Act), which strengthens the federal laws protecting employees’ rights to organize and collectively bargain.

Additionally, the administration advocated for sick days, paid family and medical leave and affordable child care. He also mentioned a need to restore the full child tax credit to offer parents more breathing room. President Biden stressed that steps must be taken to help working parents afford to raise a family and access more benefits. Ultimately, it was a call for guaranteeing all workers a living wage.

The administration is also moving to ban noncompete agreements to make organizations compete for workers and pay them what they’re worth, removing time limitations on industries or companies after leaving a job.

Health Care Prices

While progress has been made in lowering health care costs, there is still more work to be done. President Biden outlined steps to strengthen Medicare, Medicaid and the Affordable Care Act (or ACA), as well as give more families the peace of mind of affordable health care.

If drug companies hike prescription drug prices faster than inflation, they will have to pay the difference back to Medicare. And as part of a new prescription drug law that goes into effect in 2025, Medicare will cap out-of-pocket pharmacy costs at $2,000 per year under Part D. Such changes are intended to help elderly individuals save more on their health care-related expenses. Additionally, Medicare beneficiaries will pay no more than$35 per month per insulin prescription. President Biden called on Congress to extend this protection to all Americans.

Mental Health Crisis

One of the more detailed talking points in last year’s SOTU address focused on handling the mental health crisis and the White House’s related implementation strategy. While the administration made strides in 2022, including launching the 988 National Suicide and Crisis Lifeline and helping address the negative impacts of social media on today’s youth, it plans to continue tackling the mental health crisis in 2023 by:

• Creating healthy environments, such as safe online platforms for children and resources to support and build resilience in the health care workforce
• Connecting more Americans to care (e.g., affordable and accessible health insurance, integrated mental health services in schools and expanded telehealth access)
• Strengthening health care system capacity as the nation experiences a behavioral health professional shortage

Mental health is a serious concern for many Americans. The COVID-19 pandemic significantly impacted individuals’ mental health and substance use, with such challenges likely to continue as the country navigates economic uncertainty.

Veteran Support

Over the past year, the administration has expanded benefits for veterans, their caregivers and survivors. In 2022, the Department of Veterans Affairs processed a record 1.7 million veteran claims and delivered $128 billion in earned benefits to 6.1 million veterans and survivors. The administration plans to continue those efforts by focusing on:

• Reducing veteran suicide
• Expanding access to peer support, including mental health services
• Ensuring access to affordable, stable housing for low-income veterans
• Delivering job training for veterans and their spouses

Overall, these plans are meant to expand support and outreach to help the nation’s veterans.

Reproductive Health and Equality

President Biden called on Congress to protect people’s rights and freedoms. First, he urged Congress to restore the right the Supreme Court took away last year and codify Roe v. Wade. As more than a dozen states enforce abortion bans, President Biden reinforced that he would veto any national abortion ban passed by Congress.

Additionally, the administration called for Congress to pass the Equality Act to ensure LGBTQ Americans, especially young transgender people, can live safely.

Opioid and Overdose Epidemic

Another significant health care talking point involved the opioid and overdose epidemic. While overdose deaths and poisonings have decreased for five consecutive months, these drug-related deaths remain high and are primarily caused by fentanyl. As a result, the administration plans to address this by:

• Disrupting the trafficking, distribution and sale of fentanyl
• Expanding access to prevention, treatment and recovery for substance use disorders

President Biden also highlighted the Mainstreaming Addiction Treatment Act (or MAT Act) passing, which removes barriers for health care providers prescribing life-saving medications for opioid use.

Cancer Moonshot

Cancer remains the second leading cause of death in America. Last year, President Biden announced a plan to “supercharge the Cancer Moonshot,” a program that aims to cut cancer’s death rate by at least half over the next 25 years and improve the experience of people and their families living with and surviving cancer. Over the past year, Cancer Moonshot announced nearly 30 new federal programs, policies and resources to close gaps, decrease preventable cancers and support patients and caregivers.
President Biden called on Congress to drive further progress this year by:

• Urging the reauthorization of the National Cancer Act to update and modernize the nation’s cancer research and care systems
• Ensuring patient navigation services are covered benefits going forward for as many people as possible
• Helping people avoid smoking in the first place and supporting Americans who want to quit

Additionally, President Biden and Congress have already provided an initial investment of $2.5 billion to fund the Advanced Research Projects Agency for Health (ARPA-H) to drive breakthroughs in cancer, Alzheimer’s disease, diabetes and other diseases. The Inflation Reduction Act will also lower prescription drug costs for thousands of cancer patients with Medicare coverage.

Economic Recovery

Part of the administration’s efforts for a strong economic recovery includes bringing manufacturing operations back to the United States. Additionally, President Biden touted the Junk Fee Prevention Act to stop excessive junk fees, which are hidden surcharges from companies associated with the purchase of their products or services. Junk fees can make it more challenging for Americans to pay their bills or afford other expenses.

COVID-19 Emergency Periods

Prior to the SOTU address, the administration announced plans to end the COVID-19 public health emergency (PHE) and national emergency on May 11, 2023. The end of the COVID-19 emergency periods triggers the end of numerous measures related to the federal government’s pandemic response, including some requirements for employer-sponsored health plans. For example, when the PHE ends, health plans will no longer be required to cover COVID-19 diagnostic tests and related services without cost sharing. Non-grandfathered health plans will still be required to cover recommended preventive services, including COVID-19 immunizations, without cost sharing; however, this coverage requirement will be limited to in-network providers.

What’s Next?

The SOTU address serves mainly as a presidential wish list; it’s a chance for the current administration to outline where it wants to take the country over the next year. It’s unreasonable to speculate on how some of the agenda items may take shape at this time. As such, employers should look for more details about the SOTU proposals in the coming weeks and months. While some of the discussed initiatives have the potential to significantly affect the workplace, these impacts won’t be evident until more information is released.

Relation Insurance Services will keep you apprised of any additional government updates and other pertinent matters. In the meantime, contact us for additional workplace guidance.

The content of this News Brief is of general interest and is not intended to apply to specific circumstances. It should not be regarded as legal advice and not be relied upon as such. In relation to any particular problem which they may have, readers are advised to seek specific advice. © 2023 Zywave, Inc. All rights reserved.

 

How do you want to be remembered? I worked with a football coach that often repeated this to his team, and find it an interesting question for athletic trainers and anyone involved in helping provide healthcare to consider. At Relation, we care about helping our clients lead safer and healthier lives—that’s at the core of how we operate, and it’s one of the things we want people to remember about us.

That service mindset really resonates with me because I spent my entire athletic training career caring for and supporting student athletes, and striving to keep athletes at the center of every decision. My mentor consistently modeled this for me as he cared for the players and managed the conflicting interests, especially with coaches who tried to influence medical decisions.

Today, athletic trainers are still confronted with outside pressures that might not have the best interests of the athletes at heart. But, over the years, the field has seen an increased awareness of, and emphasis on, athlete-centered care in sports medicine, which has significantly influenced the decision-making process for both healthcare providers and athletes.

Practicing Athlete-Centered Care

It is now understood that one of the primary obligations as an ATC is to provide athletes (patients)—or, if applicable, their families or healthcare surrogate—with the information they need to make an autonomous decision about their healthcare. The healthcare provider should educate the patient about their specific illness/injury, the best practice available for their condition, and options for care based on the evidence, coupled with the short and long-term risk/benefits of each option. Additionally, the healthcare provider should determine the athlete’s values and goals that may influence the recommended course of treatment. (“Managing the Health of the Elite Athlete,” published in the British Journal of Sports Medicine, has some interesting thoughts on this subject.)

As an example of how athletic-centered care can look in practice, one orthopedist I worked with always followed the same multi-step method of educating patients: first, the doctor laid out the current research and evidence, then discussed their personal experience dealing with the condition, and then would offer three to four options for care and potential outcomes. The options could range from doing nothing to surgery, and it was up to the patient to take all of that information and decide their course of treatment.

The Importance of Transparency and Trust

After receiving all the information, the athlete and/or their parent usually asked me for my thoughts. They trusted me to be an unbiased voice of reason, especially pertaining to treatment and return-to-play decisions, and how that decision could impact the athlete later in life.

Giving a recommendation requires weighing the evidence, the physician preference, and the athletes’ goals in a delicate and deliberate way that gives attention to all parties and avoids conflict of interest. Keeping the patient at the center of the decision also requires an athletic trainer to strive to find a balance between evidence and preference. “Evidence, Preferences, Recommendations — Finding the Right Balance in Patient Care” by Timothy E. Quill, M.D. and Robert G. Holloway, M.D is a useful read about reconciling this tension.

When I offered advice, I was very mindful that my ultimate responsibility is always to the patient and their welfare, both immediate and long term. Many times I reminded the athlete to not only consider the present, but also think down the road—how will this decision affect them in 20 years? I asked about their life goals and listened closely to contextualize how their present-day healthcare choices could impact those goals: “You say that you want kids, and here is how this choice could impact your ability to run and play with them.” In these moments, I found transparency and trust to be essential, and the human connection that was required to discuss honestly often had the added benefit of forging life-long relationships.

Athlete-Centered Care’s Long-term Impact

Following these patient-centered principles does not always ensure a good outcome, but it does ensure that the patient had the information to make the best decision at the time. The athlete is the one who will have to deal with the impact of the decision for the rest of their life, so it is important to empower and support them in the decision-making process.

An athlete-centered approach also has the side benefit of having people remember you as someone who was honest and truly cared. Two years ago, an athlete I treated in 1985 called me looking for a surgeon recommendation because they trusted me and knew, even all these years later, that I would help them. And, earlier this year, a former football athlete reached out to my wife on Facebook with an affirming message to pass on to me:

As I get ready to go to bed and turn 40 tomorrow, please tell Andy that he was right. As I sat in the fieldhouse with the doctor getting ready to inject me so I could play and not lose my starting position, Andy looked at me and said, “You’re going to regret this when you’re 40,” and I said “I may not make it to 40.” Well I made it and Andy was right…but I am pretty sure I wouldn’t trade it for anything. Just let Andy know how much I appreciated him. I knew he was on our side and cared for us and I am, and always will be, grateful.

Keep the athlete at the center of all you do, and it will positively impact them—and you—for longer than you may know!

 

Andy Massey is an Athletics Risk Consultant for Relation Insurance. His career in intercollegiate athletics spans three decades, including Director of Athletic Training at Tulane University (LA); head athletic trainer at Appalachian State University (NC), where he also taught in the Department of Health, Leisure, and Exercise Science; and head athletic trainer at Wofford College (SC). Andy now consults with intercollegiate athletic departments across the U.S. and also serves as an ATC Spotter for the NFL. Andy can be reached via email at [email protected] or on LinkedIn.

Click here to learn more about Relation’s insurance solutions and services for Intercollegiate Athletics.

 

When I was a kid, I would work on assembling scale model kits for cars, airplanes, tanks and naval ships. My friends shared the same hobby, and while their models all looked similar but with individual variations, my completed models never looked as good. Why was that—how could that be? The model kit was manufactured at an assembly plant, the plastic parts we glued together were all uniform, and our kits had the exact same numbers of pieces in the box, along with the same instructions. Well, it turns out that I usually put my planes and cars together with significantly less time and attention to detail than my friends. I just wanted a working toy, and didn’t realize until I was older that design details are crucial to success.

Finding the Right Model of Care

In the world of sports medicine and athletic training, we are trying to build the “right” model to deliver healthcare for colleges and universities. (See this NATA Member Statement on collegiate medical models.) Everyone has access to the same research, position papers, and effective practices, and yet each program’s model of care can look different.  There is a great deal of emphasis on the medical model being the gold standard. However, the reality might be that all models—while they look somewhat different from each other—can work, so long as the model is built intentionally and carefully, and care is appropriately delivered and ongoing.

If you would like to read more on models of care and how this can impact patient care and mitigate risk, go to www.relationinsurance.com/athletic-model-of-care for an article download. 

I remember one friend’s model car of Richard Petty’s 1970 Plymouth “Superbird” that looked beautiful. The car even rolled!  One day my friend was not paying attention and crashed it into a brick wall. It wasn’t any good after that. It doesn’t matter how well something is designed and built if you don’t provide continued care.

 

Andy Massey is an Athletics Risk Consultant for Relation Insurance. His career in intercollegiate athletics spans three decades, including Director of Athletic Training at Tulane University (LA); head athletic trainer at Appalachian State University (NC), where he also taught in the Department of Health, Leisure, and Exercise Science; and head athletic trainer at Wofford College (SC). Andy now consults with intercollegiate athletic departments across the U.S. and also serves as an ATC Spotter for the NFL. Andy can be reached via email at [email protected] or on LinkedIn.

Click here to learn more about Relation’s insurance solutions and services for Intercollegiate Athletics.

 

We’re now officially in autumn, fall sports seasons are in full swing, and Halloween décor is already in stores. It’s also duck season, which I only know because my former college roommate is an avid duck hunter. He lives in Louisiana now and is excited that duck season opened there recently.

I don’t hunt, but I do spend a lot of time throughout the year tracking down best practices in athletic accident insurance. As such, I want to remind you that it’s that time again for open enrollment. Many company enrollments begin in October and healthcare.gov open enrollment begins November 1. Since athletes’ families may use this time to adjust their insurance plans, you should prepare for open enrollment’s impact on your athletic department’s excess insurance plan by monitoring changes in your athletes’ primary coverage.

The Importance of Primary Insurance Verification

Relation Insurance and its partners offer primary insurance verification services. Utilizing this service is an effective best practice to maximize the benefits of primary insurance and limit claims exposure to your excess insurance plan. If you do not currently verify primary insurance or are looking to implement a more robust system, contact your broker or insurance carrier to discuss implementation options

You likely already verified coverage and limits in the initial on-boarding process. However, it is important to plan to re-verify coverage at least two additional times each year. The first re-verification should occur sometime between the close of the open enrollment period on December 15 and the start of the spring semester. This process can help you understand open enrollment’s impact on your athletic program and catch changes that are not self-reported by your athletes and their families. Additionally, having a third verification in March/April gives you a robust process for the entire year and can help identify any changes in primary insurance that occurred during the spring, likely due to a qualifying event. Start your planning now to verify coverage after the marketplace open enrollment period ends on December 15, 2019.

 

Andy Massey is an Athletics Risk Consultant for Relation Insurance. His career in intercollegiate athletics spans three decades, including Director of Athletic Training at Tulane University (LA); head athletic trainer at Appalachian State University (NC), where he also taught in the Department of Health, Leisure, and Exercise Science; and head athletic trainer at Wofford College (SC). Andy now consults with intercollegiate athletic departments across the U.S. and also serves as an ATC Spotter for the NFL. Andy can be reached via email at [email protected] or on LinkedIn.

Click here to learn more about Relation’s insurance solutions and services for Intercollegiate Athletics.

 

 

Health insurance claims data can provide a wealth of knowledge—if you know where to look. Whether you review your program’s claims activity monthly, quarterly, or bi-annually, the process can allow you to see how the year is progressing and year-over-year performance. Think of it as an insurance plan barometer, helping identify any trouble areas that could arise. It can also be used to help you anticipate and prepare for any potential plan increases the following year.

Here are three data points to start making data-informed decisions that can help you optimize your cultural exchange accident/sickness medical insurance plan using the claims reports you already receive.

1. Are atypically large claims derailing your plan?

Large claims can and do happen, but they shouldn’t upset an otherwise stable insurance plan. However, they can affect your claims experience.  Large-dollar claims can be considered either a normal trend or an unusual occurrence. If the large-dollar claims are part of a normal trend, then they will be factored into your insurance rate going forward.

If they are considered atypical, nonrecurring large insurance charges—such as an acute condition resulting in a lengthy inpatient stay or a complex surgery—they should be separated and pooled with your carrier’s portfolio of other large claims. If you discover a large atypical claim, ask your broker if that charge is being removed from the completion factor or how it is being discounted from the experience. Familiarizing yourself with your claims trends through regular conversations with your broker will help you identify anomalies within your participant health plan as they occur, and potentially save you from a higher premium during renewal.

2. Are participants seeking care where you want them to?

Because network providers are typically more cost-effective for both the insured participant and the plan provider, in-network care, as opposed to out-of-network care, is the preferred option. A claims report can uncover behaviors that drive up plan costs such as the number of participant health care services being provided in-network.  Armed with this data, you can compare current participant activity to your program’s goals and evaluate whether or not there is a need to drive participant behavior.

Find the total allocation for in-network versus out-of-network services section of your claims reports.  Because large claims amounts can have an outsized effect, allocation data alone doesn’t tell the whole story. Examine allocation amounts in conjunction with the specific numbers of in-network and out-of-network claims to monitor out-of-network provider usage, and create program participant outreach strategies before those expensive out-of-network visits get out of hand.  If you find that 85 percent of payment allocations are in network, but only 50 percent of all total claims are filed in network it might be time to increase awareness of health care options.

3. Is there excessive emergency room use?

Your claims report can also reveal if your participants are making too many trips to the emergency room—a common problem, especially within international populations who are unfamiliar with alternative health care options. An average ER visit can often lead to claims exceeding $2,000, proving costly for both participants and health plans.

Use emergency room claims data from previous years or, if available, other programs, to provide a valuable frame of reference. Consult with your broker to determine how your program’s emergency room claim amounts compare to claims from other providers during the same period.

Check to make sure you understand what practices your plan’s claims administrator has in place to obtain proper discounts, adjudicate claims that may arise from non-emergency care, and remove unreasonable charges (whether or not they are emergency room claims).

 

Reviewing claims data before your annual policy renewal date can help pinpoint activities, utilization behaviors, or trends that will influence important decisions about your plan, such as the changing of a benefit offering or the incorporation of a different network.

If diving into data analysis seems daunting, there’s good news—you’re not alone. Your broker or health plan provider can be a valuable partner in the process by regularly reviewing claims data with you and conveying what that data means for your program.

Schedule a claims data review to more fully evaluate the intricacies of your cultural exchange program’s accident/sickness medical insurance plan and manage it more strategically and sustainably.

 

-Michael Babore

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To read more about Relation’s cultural exchange services, visit this page.

 

Hi, I’m Jesper Tejsen Lykke, the new Vice President, Global Markets for Relation’s Education Solutions practice group. I’ve been working in the international travel industry for more than 30 years and have always been passionate about the educational and cultural value of cultural exchange. I am delighted that my path has brought me to Relation and back to this world.

Cultural exchanges provide an opportunity to explore other countries’ traditions, customs, beliefs, societies, languages and much more and provide opportunities for participants to view the world with a different lens. Here in America, cultural exchange brings non-U.S. residents to the country on short-term visas to take up temporary positions as au pairs, camp counselors, interns and trainees, summer work/travel visitors, professors, and visiting scholars. United States-based companies and organizations act as the host, provide placement, and provide or coordinate the visa and insurance components.

Cultural exchange helps make our world more connected, and without the sponsorship of those host companies and organizations it wouldn’t be possible. Yet they are often time- and resource-strapped, especially when it comes to handling claims. I’m especially excited then, that Relation is now serving the in-bound international exchange market because we are both broker AND an experienced third-party claims administrator, which lets us support our partners every step of the way. Our team also brings valuable resources, technology solutions, and infrastructure to the table that can help reduce the administrative burden for sponsoring organizations and create more program sustainability.

Personally, I am looking forward to returning to an industry where I have decades-long ties and many great friends. I’m also excited to be developing deep partnerships, finding creative solutions, and helping create a safe, smooth experience for partners and participants alike. Our goal at Relation is to do everything we can to support the great opportunity that cultural exchange is, while helping improve program outcomes.

In the coming months I’ll be on the road at WSTC and ICEF Berlin and hope to see you out there. I’ll also be sharing insights and resources on Relation’s blog that can inform the work of time-pressed program administrators as they support participants. First up: Unlocking Claims Data: 3 Data Points to Help Optimize Your Cultural Exchange Insurance Plan.

If you’re interested in signing up to get notified when I post on the blog, click here…and in the meantime you can always find me on LinkedIn. If you’d like to read more about Relation’s cultural exchange services, visit this page. (My contact information is there, also.)

By Michael Babore, Executive Vice President, Ascension Collegiate Solutions

I have worked in the student insurance marketplace for over 15 years. With the implementation of the Affordable Care Act (ACA), the past three years have been the most challenging for our clients and the marketplace in general.

The first challenge was understanding how the ACA would affect student health insurance plans (SHIPS). SHIPs aren’t like employer plans, and also aren’t like other types of individual plans, so we worked hard with our underwriting partners to understand the new regulations and make the necessary policy adjustments.

But that was only the first step. Next came implementing plans with expanded benefits and higher premiums. For some colleges and universities that had historically offered low-cost, limited-benefit plans that suited a young and healthy population, the higher costs associated with ACA-compliant plans was shocking. At the same time, the state insurance Exchanges came online, offering an option previously unavailable to college-age students. There was also a strong push by the Exchanges to get younger people on these plans with targeted marketing campaigns.

However, now that we have a clearer view of the ACA in terms of the both its regulations as well as what kinds of plans are being offered through the Exchanges, we have a lot more information to help determine what is the best option for students at higher education institutions.

Let’s take a closer look at the Exchanges versus SHIPs.

Exchanges

1. Affordability

   – Plans are generally affordable and priced based on health history as well as income. This seems like an advantage for the “young and healthies” that typically make up college populations. However, students that access the Exchanges for an affordable option often just select the cheapest Bronze option, a High Deductible Health Plan. From the student’s perspective, they are covered and can forget about it. The reality is that the student will still have to satisfy a large deductible ($6,600 for most Bronze plans). Too many students do not understand this, and find themselves paying out-of-pocket for day-to-day accidents or illnesses. Many, if not most, students don’t have the money required to satisfy the first $6,600 of their medical expenses, which could result in students having to decide whether to pay for their education or pay for medical treatment. Since 98% of all medical claims are under $5,000[1], this puts the responsibility of paying for their healthcare squarely on the student’s shoulders.

2. Subsidies

   – The subsidies offered to people in certain income brackets may sound appealing to students, as they perceive that subsidized Exchange plans are more affordable than the student health plan offered by their school. However, a recent study by the Kaiser Family Foundation that focused on IRS penalties in 2014 found that over 50% of individuals who accepted a subsidy for health insurance were not eligible for the amount they received[2]. We hear frequently that students are going to the Exchanges and answering the income questions accurately from their perspective, only to find out that mom and dad are claiming the student as a dependent on their tax return. Since subsidies are based on the total household income, families will be required to pay back the subsidy a student received in error. In this instance, what originally seemed to be a great value to the student has turned into a tax burden for their family.

3. International Students

   – Not only can the Exchanges be confusing for international students, but this population is not eligible for subsidies or Medicaid, since those are for U.S. Citizens or permanent residents only. Without guidance from foreign student advisors or insurance professionals, these students are unassumingly accepting subsidies without fully understanding the ramifications for doing so. In the past year our firm has seen a large increase of international students being deported for violating the terms of their visa.

4. PPO Networks

   – While Exchange plans have access to national PPO networks, the networks affiliated with Exchange plans are often limited networks, especially in non-metro areas. What’s happening is that national PPO networks will offer a much smaller network carve-out to Exchange plans. We’ve heard reports (and seen first-hand) of signs in doctor’s waiting rooms saying they don’t participate in the Exchange PPO network. The result is that students are left with few choices of in-network providers near campus, and end up paying the higher out-of-network prices – including coinsurance, deductible, and out-of-pocket max – for services they need.

SHIPs

1. SHIPs help the school’s bottom line.

   Our consultants have reported that many colleges and universities no longer see the value of providing a comprehensive health insurance plan to their students. The simple truth is that requiring students to have a health insurance plan is in the best interest of the college or university; keeping students healthy and enrolled has a significant impact on the school’s bottom line.

2. SHIPs are usually the best deal for students.

   Many think the Exchanges are good enough for their students. However, as I pointed out earlier, Exchange plans often include really high deductibles which may be financially overwhelming to a student trying to pay for college. SHIPs, on the other hand, generally have low deductibles, coinsurance, and copays. That means a student enrolled in a SHIP can get the care they need right away, without the need to pay for all expenses out-of-pocket until they meet a (generally unattainable) deductible.

3. Health Center Tie-In (and Buy-In).

   A lot of students are going off-campus to seek medical care, rather than utilizing the on-campus health center. SHIPs can coordinate with student health centers, which can help bring more students in and increase revenue for the campus, as well as keeps insurance costs down for students. It’s a win-win.

4. SHIP premiums are competitive

   Sometimes we hear that SHIP premiums are high compared with Exchange premiums. However, a lot of the low-priced plans on the Exchanges have high deductibles and limited networks (therefore a lot of the charges are being paid at the out-of-network prices). The reality is that, if you are making an apples-to-apples comparison, SHIPs are often less expensive than Exchange plans or than students being insured as dependent on a parent’s plan. Since SHIPs now offer full coverage (rather than limited benefits with low benefit maximums that they did in the past), SHIPs are more expensive than they used to be; however, the value of SHIPs has increased as well.

The bottom line is that a quality insurance plan can cover the costs of high medical expenses that could otherwise prevent a student from continuing his or her education. It’s important to consider all the ramifications to students of sending them off to the Exchanges. For many students, the Exchange reality is very high out-of-pocket expenses, few in-network doctors, and not much coverage in the absence of extreme illness or injury. SHIPs might not be the answer for every campus, but I truly believe that in most cases, they can offer students and schools a much better option.

 

Michael Babore has worked with colleges and universities since 2000, developing roadmaps for successful student health insurance programs. His goal is to deliver the service each and every client requires. Prior to joining the Ascension team, he worked as the Head of Sales for HTH Worldwide in their international student insurance division. Michael is a member of NAFSA,ACHA, URMIA, NAICU and the FORUM. He is a regular presenter at many industry-related events and has traveled to 22 countries in his career. For more information, contact Michael at 310-255-2061 or [email protected].

[1] Claims data based on breakdown of claims for students insured through Ascension for the 2013-2014 and 2014-2015 academic years.

[2] Cox, Cynthia, et al. “Repayments and Refunds: Estimating the Effects of 2014 Premium Tax Credit Reconciliation,” March 24, 2015. Kaiser Family Foundation. Web. <http://kff.org/health-reform/issue-brief/repayments-and-refunds-estimating-the-effects-of-2014-premium-tax-credit-reconciliation/>