$225,000 Premium / $0 Deductible. $98,000 Premium / $0 Deductible. $110,000 Premium / $0 Deductible
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1 1
2 $225,000 Premium / $0 Deductible $98,000 Premium / $0 Deductible $110,000 Premium / $0 Deductible $225,000 Premium / $0 Deductible JC with 200 Student Athletes $98,000 Premium / $0 Deductible Div I-A with 400+ Student Athletes $110,000 Premium / $0 Deductible Div II with 200 Student Athlete (No Football) Why 2
3 Crucial to Understanding the Risk Types of Reports Detail vs. Aggregate By: Provider, Dx, $ Amount, Sport, Gender, Accessibility of Reports Online vs. By Request Claims with and without COB (Coordination of Benefit) Discounts Insured vs. Uninsured 0% Percent Insured 100% Insured Student Athletes (90%) Uninsured (10%) With COB (50%) Without COB (40%) Note: Although 90% have insurance, only 50% have applicable insurance COB: Coordination of Benefits 3
4 Primary Insurance (with COB)= 45 Total Charge = $155, Other Insurance Paid= $144, Total Paid = $11, In Network (No COB) Total Claims= 23 Total Charge= $87, Discount Amt= $23, Total Paid = $55, Out of Network (No COB) Total Claims= 14 Total Charge = $39, Total Paid = $39, Secondary Insurance Payments W/ Primary No COB (In-Network) No COB (Out-Netork) 37% 11% 52% No Insurance / No Responsibility Traditional / Fully Insured Plans Low Deductible Plans $110,000 Premium with a $500 Deductible (Disappearing) High Deductible Plans $65,000 Premium with a $7500 Deductible Aggregate Plans $50,000 Premium with a $150,000 Aggregate Deductible ( Family Deductible) Self Insured Programs 4
5 Advantages If $0 or low deductible can predict annual expenses If $0 deductible easy to determine responsible party Disadvantages Bill Paying Service Volatile Student Responsibility? Advantages Lower Premium Potential for Savings Disadvantages Unknown Out of Pocket Expenses Difficult to evaluate if attempting to pursue low deductible programs Claims coordination 5
6 What is OOP? Out of Pocket Expense to Meet Deductible School Paid and / or Student Paid Important when looking to change to higher / lower deductible options Determining Total Cost of Healthcare Insurance Premium + OOP = Total Cost of Healthcare 1. Yes 2. No 0% Yes No 6
7 Advantages Lower Fixed Cost Potential Return of Unused Claims Money Not fully funding the claims account. Discretionary spending Disadvantages Education to Administrators Claims Coordination If pierce deductible, subsequent cost TRADITIONAL $0 DEDUCTIBLE $100,000 Premium / $0 Deductible $100,000 Paid to Insurance Company on 8/1 Claims = $60,000 Claims = $160,000 AGGREGATE DEDUCTIBLE $30,000 Premium / $70,000 Deductible $100,000 Paid to Insurance Company on 8/1 Claims = $60,000 School Receives Check for $10,000 Claims = $160,000 Insurance Company Responsible for $90,000 7
8 University HMO Potential for High Risk Forced or Chosen Self Insurance Potential Institutions attempting to obtain traditional insurance programs NCAA Implications Discounting of Claims How to compare programs. 8
9 Add your insurance premiums with out of pocket expenses (those dollars spent to meet deductible limits or uncovered expenses) Example: $65,000 Premium with a $5000 Deductible Assume the school spends $70,000 to meet the $5000 deductible Total Expenses = $135, Plan A: $125,000 Premw/ $0 Ded 2. Plan B: $85,000 w/ $5000 Ded 0% Plan A Plan B 9
10 Plan A: $125,000 / $0 Plan B: $85,000 / $5000 Potential $40,000 savings Must have all SA on good insurances Must adjust PCP to Local Providers Must Preauthorize Services Must Negotiate Fees with Providers 1. Plan A: $125,000 Prem. w/ $0 Ded. 2. Plan B: $85,000 Prem. w/ $5000 Ded. 3. Plan C: $45,000 Prem. w/ $90,000 Agg Ded. 0% Plan A Plan B Plan C 10
11 Carrier A: $0 Deductible / $165,000 Premium Carrier B: $1000 Deductible $200,689 Premium Carrier B: $160,000 Agg Ded. / $48,500 (Premium / Cost) Carrier C: $160,000 Agg Ded. / $46,700 (Premium / Cost) Carrier A: $150,000 Agg Ded. / $50,000 (Premium / Cost) Carrier A: $0 Deductible / $165,000 Premium Carrier B: $1000 Deductible $200,689 Premium Carrier B: $160,000 Agg Ded. / $48,500 (Premium / Cost) Carrier C: $160,000 Agg Ded. / $46,700 (Premium / Cost) Carrier A: $150,000 Agg Ded. / $50,000 (Premium / Cost) 11
12 FULLY INSURED OPTIONS Carrier A: $108,289 with $0 Ded Carrier B: $120,433 with $0 Ded Carrier A: $92,793 with $1000 Ded AGGREGATE OPTIONS Carrier A: $83,000 Aggwith a $32,000 Premium Carrier C: $100,000 Agg with a $29,000 Premium Carrier B: $92,816 with $1000 Ded Carrier A: $66,598 with a $5000 Ded $5000 Benefit on a Mandatory Student Athlete Plan ($165 per student athlete) (298) Carrier A: $66,598 with a $5000 Ded Carrier C: $50,000 Agg with $19,500 Premium 12
13 Requiring Primary Health Insurance Charging Student Athletes a Participation Fee to cover deductible Requiring Student Athlete to be responsible for school deductible Require Student Athlete to be responsible for family / personal deductibles Exit Physicals / Interview 13
14 MAXMIZING Primary Insurance Mandating Primary Insurance w/ Athletic Benefit Adjusting PCP to Team / Local Physician Preauthorization prior to services Negotiating Fees with Providers Proper Claims Processing NOI / HCFA / EOBs 14
15 Many schools (regardless of classification) require primary insurance for athletic participation regardless of university enrollment requirements. What happens when student athletes report to campus with PHI (Primary Health Insurance)? Student Health Sponsored Program Athletic Benefit? International Students Athletic Benefit? 15.3 Uninsured Insured
16 16 MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH States with Greater than 20% Uninsured Employer Medicare Medicaid Private Millitary
17 0% Percent Insured 100% Insured Student Athletes (90%) Uninsured (10%) With COB (50%) Without COB (40%) Note: Although 90% have insurance, only 50% have applicable insurance COB: Coordination of Benefits 17
18 Pre-Season Exercise Categories F = No Insurance / Government Insurance / Kaiser = 25% C = HMO with PCP not local / team physician = 50% A = Private / HMO with local / team physician = 25% How do we get more students into A Category? Require / Purchase Insurance for No Insurance Adjusting PCP to Team Physician Collection of Information Follow-up Introductory Letter Parent Call to Parent (Subscriber) to Inform Parent (Subscriber) Must Call Insurance Company and Request Dependent to have different PCP Note: Only adjust dependent Success Rate = 65% (Personal Experience) Non $$$ advantages of PCP adjustment Time, Time, Time Do they change back for summer? Plan B: Guesting Privileges 18
19 0% Percent Insured 100% Insured Student Athletes (98%) Uninsured (2%) With COB (60%) Without COB (38%) Note: Although 98% have insurance, only 60% have applicable insurance COB: Coordination of Benefits 0% Percent Insured 100% Insured Student Athletes (98%) Uninsured (2%) With COB (90%) Without COB (8%) Note: Although 98% have insurance, 90% with applicable insurance COB: Coordination of Benefits 19
20 Secondary Insurance Claims $451,600 60% with COB $341,800 $135,050 90% with COB Decrease in Injuries / Time Loss Decrease in Surgeries More Students with COB Understand Other University Relationships Never sacrifice access, quality or follow-up interaction Geography Influence Access to other similar providers Where do I start? Data, Data, Data How many services provided (MRI, surgery, office visits)? Relationship May include marketing leverage 20
21 Accepting Primary Insurance as Payment In Full Flat Rate Difficult with multiple services being provider at a single provider. DX: MRI + all variations, CT, X-ray, US, Etc % of Billed Charges Dependent upon the billed amount thus can increase just by the provider to raise the rate % of Medicare Rate Example 125% of Medicare Rate for All Services 21
22 Variable Reduces with efficiency and system Insurance Coordinator? Outsource components? Head ATC Campus Risk Manager AD Financial Insurance Coordinator Coach 22
23 Contracting with Providers Primary Insurance Utilization PCP Adjustment Mandates Purchasing Proper Claims Processing Insurance Coordinator 23
24 Target Claims: 65% of Premium Meaning: Expected Claims of $65,000 = Premium of $100,000 Expected Claims of $100,000 = $153,846 Components of Premium Claims Base (65%) TPA Services (8%) Sales Commission (8 12%) Insurance Reserve / Profitability (15 19%) Aggregate Differences 24
25 Utilize Networks for Discounting of Claims with No COB Example: If 20% have no insurance or no applicable coverage for athletic insurance = 400 x.20 = 80 Enroll 80 SAs into a Direct PPO Network: $8 -$12 per person per month + Discounting Fee Typical Secondary Network Wrapped Network Global Excel Beechstreet TRADITIONAL Average Claim Base: $85,000 Proposed Premium: $136,000 with $250 Ded Anticipated Total Cost $150,000 SELF-INSURED / DISCOUNTING Set Aside $150,000 Enroll 80 Students into Direct PHCS Network: 80 x $144 = $11,520 25
26 COB CLAIMS 48 of 360 students with valid / applicable insurance had a claim Total School Responsibility = $32,400 (Co-pays, Ded., Etc.,) Processing Fee: 5% ($1620) Total Expenses: $34,020 NETWORK CLAIMS 18 of 80 students enrolled in network had a claim Total Charges: $64,800 Network Discounts: $28,512 (44%) Discount Fee (20%): $5, Remaining Balance: $36,288 Set-up Fee: $11,520 COB Claims: $32,400 Processing Fee: $1620 No COB Claims: $36,288 Discount Fees: $5, Total: $87,
27 Dinner Tonight? Breakfast Begins at 7:30AM Tomorrow Thank You for Your Participation and See You Tomorrow 27
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