1. Student Health Insurance Anita Barkin November 21, 2002

2. Current Program Voluntary program Three options for coverage

3. Strengths Rich in benefits Enrollment of over 2000 due to strong marketing effort GSA support for the program

4. Weaknesses Adverse selection Substantial increases in premiums –high loss ratios –changes in the student insurance market Uninsured and underinsured graduate students and international students

5. Changes in the Market Fewer carriers are in the student insurance market Fewer carriers are submitting proposals for voluntary programs Student plans are experiencing cost increases in four areas: outpatient, inpatient, prescription drugs and physician services (Cronin, 2002)

6. Benchmarks Survey of top 25 schools –18 have a mandatory/hard waiver program for all students –2 have a mandatory/no waiver program for all students –1 has a mandatory/hard waiver for undergrads and a mandatory/no waiver program for grads and international students –2 have a mandatory/hard waiver for some populations –2 do not have a mandatory program

7. Schools with Mandatory Programs Ten of the eighteen mandatory/hard waiver programs also require that the private insurance meet certain minimum standards in order to qualify for the waiver

8. Recommendation Adopt a mandatory/hard waiver insurance policy for all enrolled full-time students, effective Fall 2003 Change insurance plan to two options

9. Rationale Supports student retention –Individuals who are uninsured or experience a change in their insurance are less likely to seek care for illness/injury in a timely manner or use preventive services (Smith, 2001) –Protects students from significant medical expenses that can impact financial stability and the ability to continue one’s education Protects the public health of the campus community and reduces risk to the university Reduces risk of adverse selection –Potential reduction in premium of 19% +/- 4%

10. Implementation The charge for the basic mandatory plan will be placed on the student’s Fall invoice Students will be required to present proof of insurance in order to have the charge removed by the end of the open enrollment period Students can upgrade their plan within the open enrollment period

11. Requirements for Waiver Documentation of coverage as the dependent, partner/spouse, or principle in an employer or government sponsored group benefit program that meets accepted minimal standards

12. Immunization Requirements

13. Current protocol All undergraduate students must have either two doses of measles vaccine, demonstrate immunity or apply for religious or medical exemption All undergraduate international students must have a TB skin test within one year of arrival Graduate students are not monitored for compliance

14. Enforcement 100% compliance for measles vaccination in first year population –Residential privileges are withheld –Hold on Spring registration

15. Senate Bill 955 Requires all students living in residence halls be vaccinated against meningitis or sign a waiver Signed into law June 28, 2002 –effective August 29, 2002

16. Weakness of current protocol Process is labor intense and inefficient Does not provide adequate protection for the campus community against vaccine preventable infection –Outbreak of a contagious disease that can be very costly to an institution and have a significant impact on university activities

17. Benchmarks 15 schools surveyed –14 have a prematriculation immunization requirement for both graduate and undergraduate students 14 require MMR (measles, mumps, rubella) 3 recommend Hepatitis B, 3 require it for all students, 5 for health professions –1 does not have immunization requirements

18. Recommendation Adopt a mandatory prematriculation immunization requirement consistent with Pennsylvania State Department of Health recommendations for all incoming full-time students effective Fall 2003

19. Vaccine requirement All full time students –Two doses of measles vaccine –One dose of rubella and mumps All students residing in university housing –Hepatitis B vaccination series –Meningitis vaccination Tuberculin skin testing for all international students

20. Exceptions Waivers for religious and medical reasons Waiver from TB skin testing based on country of origin

21. Enforcement Impose a $50 penalty for noncompliance by first day of class in August Place a hold on Fall registration

23. Premium History

24. Undergraduate Enrollment in Student Health Insurance

25. Grad Student Enrollment