Following are answers to the most common questions we have received over the past four months:

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1 Dear UIW Employee, We understand that health insurance is very personal, and change can bring many questions. Now that we are four months into the change from Aetna to Gilsbar as our third-party administrator (TPA), we want to share information with you as we seek to continually improve the plan experience. We thank you for the many constructive comments received. We have captured and answered the questions in the various categories below. The Insurance Benefits Committee will have its first meeting of the academic year on Monday, October 22 at which time we will review the plan performance, both wins and challenges, and begin planning for next year. We ask you to please provide any further comments, concerns, and recommendations on the UIW health, pharmacy, and dental plans at As a reminder, the Human Resources Benefit s webpage is regularly updated with information and resources about the health plans, including frequently asked questions, balance bills, speaking to my medical provider, and much more. HR will also periodically issue communications with information about our health insurance plans and to address frequently asked questions from members of the UIW community. Following are answers to the most common questions we have received over the past four months: UIW offers self-funded health care. What does that mean? Self-funded health care is one in which the employer is essentially providing the healthcare benefits to employees and their families using the employer s own funds and employee premiums. UIW became self-insured in UIW therefore assumes the direct financial risk for payment of the claims submitted by your healthcare providers. UIW annually sets premiums to best approximate the total amount of claims it must pay and healthcare benefits it provides. This is calculated at the shared split of 50% for employees and 50% for UIW. Who is our insurance carrier? UIW is your insurance carrier. You have an employer group health insurance plan (UIW insurance). UIW has utilized a third-party administrator since it became self-insured to administer the UIW insurance plan. Since this is a group plan, all employees in the group share in the costs incurred by insured individuals. We are all in this together. Is Gilsbar my health insurance carrier? No, Gilsbar is not your insurance carrier; it is a TPA. Gilsbar is nationally recognized as one of the top TPAs in the country and has been in business since UIW entered

2 into a two-year contract with Gilsbar to process the claims submitted by your healthcare providers, so that UIW can then pay the claims pursuant to the plan that you selected. Essentially, Gilsbar facilitates communication between UIW (your insurance carrier) and your healthcare providers. What is Reference-Based Pricing? Reference-Based Pricing (RBP) is a system of determining medical payments based on published Medicare rates. UIW has agreed to pay 120% of the Medicare rate or other negotiated rate for all services covered under our Bronze and Silver medical plans. Since these plans are not tied to a network, RBP permits employees to visit the provider of their choice while considerably reducing healthcare costs. Many companies in San Antonio with collectively thousands of employees use RBP, such as Bill Miller, GVTC, Ancira, Texas Med Clinic and Brake Check. The Texas legislature continues to study RBP for state employees. RBP is an increasingly common model for employer provided health insurance. Who pays what portion of my healthcare costs? Because UIW is self-funded, UIW pays for all healthcare costs that are covered in your healthcare plan. In addition, UIW currently pays 50% of monthly insurance premiums for every employee, which means that UIW matches every dollar an employee pays for his or her monthly medical premium. UIW also provides a monthly subsidy for employees who earn less than $47, per year. What is CareValent? CareValent is a patient advocacy service that works with your medical providers in negotiating rates of services and settling any balance bills on your behalf. Employees on the UIW Bronze and Silver plans can contact CareValent at any time to request advocacy services with their medical providers at UIW has been proactively working with CareValent to obtain agreements with medical providers, urgent care facilities and hospitals, since UIW entered into the contract with Gilsbar. Some of the major medical groups with whom UIW has agreements with are: Texas Med Clinic, UT Health Physicians, San Antonio Orthopedic Group, and BHS Physicians network. UIW also has agreements with many small or individual physicians offices. Although CareValent has initiated agreements with many providers, Bronze and Silver Plan members are not limited to these providers. We continue to work closely with CareValent to identify medical networks where our employees seek care to proactively obtain agreements with these providers. How are my doctor s bills paid?

3 The medical provider submits the claim to Gilsbar. Gilsbar determines the amount owed to the provider based on the plan document. Gilsbar then facilitates payment from UIW s account to the provider. On the Cigna plan, providers are paid based off the PPO negotiated rates between Cigna and the provider. The UIW Bronze and Silver plans calculate payments to providers on the Medicare fee schedule, plus 20%. In some instances, payments could be even greater than 20% above Medicare. What if I get a Balance Bill? With any type of plan, whether a PPO plan or RBP-No Network plan, sometimes despite accepting the plan s allowable charge as payment, providers attempt to further collect funds from you that are above and beyond the maximum amount payable by the plan or any copay, coinsurance, or deductible you may owe. This is called balance billing. If you enroll in the UIW Silver or Bronze health plans, and a provider or any agency contacts you seeking payment for a balance bill, contact Gilsbar at without delay. Gilsbar will determine if the bill is a balance bill and not an owed patient responsibility such as copays, deductibles or coinsurance. If it is a balance bill, Gilsbar will put you in contact with a CareValent Patient Advocate who will provide assistance and support to resolve it. Please note that this process takes time and is subject to the responsiveness of the provider s office. I am concerned that I will be sent to collections for non-payment if Gilsbar has not paid my doctor because CareValent has not been able to reach an agreement for payment with my doctor. What can I do? The UIW Bronze and Silver plan operate using RBP, and members of these plans do not need to have a payment agreement in place with their providers prior to seeing them for service. Gilsbar will facilitate payment to your provider based off the UIW plan document once a claim is received. You should be proactive about your medical care and work with your provider s billing manager as well as utilize the patient advocacy team at CareValent to resolve billing issues with your provider. The CareValent Patient Advocate will always keep you informed of status during the resolution process. You will receive copies of any correspondence sent to the provider by CareValent. This correspondence will communicate to the provider that CareValent is working on your behalf regarding your bill. It will also remind the provider of your consumer credit protection rights while an outstanding medical charge is in dispute. I am on the Cigna plan, what does this mean? UIW has one medical plan that does not use reference-based pricing and that has a predefined network of providers. UIW has purchased access to Cigna s PPO network as an option for employees who did not want the reference based pricing medical plans.

4 While the medical plan is still insured by UIW and administered by Gilsbar, the healthcare providers in the network are determined by Cigna, not UIW. Who was involved in the decision to switch third-party administrators and insurance plans? Decisions about benefits are made by the Insurance Benefits Committee, which includes faculty and staff, and are then submitted for approval to the President s Advisory Council (previously known as the Executive Committee.) The current UIW Insurance Benefits Committee is comprised of members: Dr. Jeff Copeland, Dr. Shandra Esparza, Idalia Rodriguez, Janine Chavez, Dr. Trey Guinn, Elisa Gonzales, Scott LeBlanc, and Annette Thompson and Shannon Root on behalf of Human Resources. Vice-Presidents Sr. Walter Maher, Cindy Escamilla and Doug Endsley also serve the Committee as follows: Sr. Walter provides guidance to the Insurance Committee on Catholic Church guidelines, especially with respect to the Affordable Care Act contraceptive mandate, Cindy Escamilla provides legal guidance, and Doug Endsley addresses the financial aspects of the plan, such as premium reserves, plan payments and expenses. UIW also utilizes an external insurance consultant to help us navigate the complexities of health care. Why did UIW not renew Aetna as our third-party administrator and insurance provider? The rising costs of Aetna s predefined network of providers year to year became unsustainable. The Insurance Benefits Committee decision to change our third-party administrator was primarily based on keeping medical premiums at an affordable rate and as low as possible for University s employees while maintaining the same rich levels of benefits and retaining Grandfather status under the Affordable Care Act. Maintaining the same benefits with either a premium increase on the one hand or a change in the insurance plan design on the other is where most businesses find themselves annually, and UIW is no exception. UIW s decision is further complicated by UIW s choice to retain Grandfather status under the Affordable Care Act, which limits our ability to make any benefit changes that might yield cost-savings. A renewal with Aetna was the first consideration. As in prior years, Aetna was invited to submit a renewal bid, as were other insurance company TPAs. Aetna s renewal came with a 30% increase, on top of Aetna s increases of at least 15% annually for each of the previous three years. Combining Aetna s proposed 30% increase with the three prior years increases, would mean a 75% cumulative increase in four years. Aetna further declined to permit UIW to audit the claim handling and to review its provider contracts, which would have allowed UIW to better understand and reduce costs. Based on current and constant utilization rates of UIW employees, would be on track for another major increase, making the premium for health insurance even more

5 unsustainable for UIW s workforce, staff and faculty alike. Unfortunately, the bids from other insurance company TPAs did not yield a lower cost. Therefore, in order to manage costs and keep premiums at the current affordable rates, while still providing the same levels of coverage and maintaining Grandfather Status, the Insurance Benefits Committee unanimously voted to adopt reference-based pricing and selected Gilsbar as our TPA to administer the plan. Cigna was also offered as a traditional PPO option for employees who wanted a defined network of providers at the increased premium that employees would have paid with Aetna. The Insurance Committee s recommendation was then presented to Executive Council (now the President s Advisory Council) which approved the Insurance Benefits Committee s recommendation. Why does UIW maintain Grandfather Status under the Affordable Care Act? Under the Affordable Care Act, if an employer makes any changes to its health plan coverage, the employer health plans must offer the full array of covered contraceptive methods. These methods are contrary to the guidance of the Catholic Church. Therefore, UIW has not made any changes to the health benefits. By maintaining Grandfather Status, the University is legally permitted to avoid providing coverage for the full array of contraceptive methods under the Affordable Care Act. Where can I submit feedback regarding UIW s health plans? Employees can submit comments, concerns and recommendations regarding UIW s health plans at Where can I find information about our health plans? Employees can find information about UIW s health plans at The website includes frequently asked questions, how to talk to your provider, how to handle a balance bill, information about MDLive, Asserta Health and much more. Information can also be found on We remain dedicated to serving our employees and working diligently to provide medical benefits that will foster the health and well-being of our UIW community. We thank you for your patience as we make this transition. We have had some successes but still face many challenges as we enter this fourth month under our new TPA. We value your thoughtful input and look forward to the great responsibility of stewarding our resources and maintaining a high level of care for our employees now and in the future.

6 Sincerely, Annette Thompson UIW Chief Human Resources Officer