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University insurance plan subsidized, yet still pricey

By Alban Murtishi
On April 20, 2014

   Michael Kurland, director of Student Health Services, is a key player in making sure that graduate students not only get the care that they need, but get it at the right price. Graduate students operate on a set of rules and regulations separate from undergraduate students. Health insurance is a prime example of those differences.
Insurance benefits are derived from a large chain of command. At the top of that chain is Nationwide Insurance, which actually provides the insurance.
"Think of Nationwide as the big bank that gives the money and takes the risks," Kurland said.
Cigna is the network that actually recruits doctors into the plan so that they will charge patients a negotiated price with companies in the Cigna network.
Kurland provides an example to detail Cigna's role, and the role of networks like Cigna that affect pricing for students. If a student has an appendectomy and they're out of network so the doctor can charge them $3000 for the service. The insurance company's data shows that most doctors in that region charge $2500 (formally the "reasonable and customary" price) for the same procedure, so the insurance company will pay 90 percent of the $2500 if you are in-network with Cigna. Out of network Cigna will still offer for the negotiated price of $2500, but will only cover 70 percent.
"In network doctors have accept the insurance companies rates, so theres always an advantage to being in network. Physicians in network have signed a contract agreeing to that hypothetical amount," Kurland said.
Consolidated Health Plans, or CHP, actually process all the claims, calculates the copay and pays the doctor what insurance covers.
 "Generally speaking if we get a complaint it will be about CHP because they would be the one who would actually deny your claim," Kurland said. "We assist the student by advocating on their behalf to CHP."
The other name most graduate student will be familiar with is Bailey Agencies Insurance, who actually sign up students for the plans and distributes insurance cards. There are about 5000 enrollees between graduate assistants and graduate fellows.
Because of the large number of enrollees, UConn health insurance bids out a competitive $20 million contract to companies like Bailey Agencies in order to gather the best plan for students. The contract can be renewed every years, and so far Bailey Agencies has been with UConn 20 years.
"We bid out the insurance, and then its yearly renewable, and we can refuse to renew after year one, we believe Bailey Agencies are doing a good job servicing students," Kurland said.
 According to Bailey Agencies' website, general pricing for graduate students ends up costing about $4000 annually, but with UConn subsidies that is reduced to about a $200 annual deductible.
"We think it's a good plan, however, there are definite expenses that the patient incurs, for example if you're in network there is an annual deductible of $200 per person, also, you pay 10 percent of in-patient hospital expense, same thing for emergency room expenses." Kurland said.
Kurland also mentions that the cost-benefit of the plan is also relative to how the pay of graduate assistant or fellow. While $200 is a low deductible, the in-patient hospital expense could be $2500, 10 percent of that paid by the student is $250.
Kurland also details that there exists some holes in coverage, especially for specific vaccines not explicitly covered by the plan.
"Lets say you come in for a travel vaccine that costs $300, if the insurance doesn't cover that vaccine, you will pay $300," Kurland said. "However, by and large most items provided by students health services would be at no charge."
Also interesting about the plan is that it coincides with the Affordable Care Act [ACA] which was officially started last December. Student Health Services have worked within the many guidelines of the act, also known as Obamacare.
"We met the 2014 standards two years before they came into effect." Kurland said.
Benefits derived from this include that patients cannot be denied insurance for preexisting conditions. Obamacare also reduces the amount of profit the companies can derive from deductibles and copays.
"Under the ACA, insurance companies are limited to a certain profit margins, you could have a 100 players in the game and their all splitting that small pie." Kurland said.
 


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