1. Student Health Insurance Representatives Meeting November 21, 2005

2. Problems Duke Plan health insurance premiums have increased at annual rates of 18%,23%, and 21% for the last 3 years These rates exceed all other components of the cost of education and cost of living at Duke A 20% increase for 2006-2007 would mean a premium of $1907, not including the Student Health Services annual fee ($524+ plus summer). Family Plan requires premium subsidy by single students, and does not accommodate all sizes of families

3. Result Burdensome costs for students on Duke’s Plan are becoming overwhelming Some healthy students seek lower cost insurance in private market, driving up average utilization per student on Duke Plan Frequency of underinsurance increasing Duke is less attractive to prospective students compared to peer institutions with better health insurance support

4. GPSC’s Actions: Internal Develop internal structure within GPSC to address health insurance annually with continuity Create standing subcommittee featuring leadership cultivation and strong presence on Student Health Services’ Student Health Insurance Advisory Committee (SHIAC) Improve information exchange with students Leverage Young Trustee to coordinate BOT subcommittee representatives to address issue at Feb meeting in unified manner

5. GPSC’s Actions: External Work closely with Deans, Student Affairs and Student Health Services to communicate our values, objectives and proposals and provide feedback on their ideas Memorandum to Board of Trustees to elevate awareness of health insurance as critically important to students –Statement of Our Values Regarding Health Insurance These values will guide our decision-making around proposals for achieving our objectives –Statement of Our Immediate and Long Term Objectives Approval of GSAS plan to subsidize health insurance for all doctoral students Incorporate discussion of health insurance costs into ongoing strategic planning for Financial Aid Campaign Plan for institutional coverage of health insurance for all graduate and professional students –Offer Proposals for Achieving Our Objectives

6. Timeline –November 21: Meeting with GPSC Representatives –November XX: Obtain feedback on issues from GPSC Representatives –December XX: Update to GPSC Representatives on Values, Objectives and Proposals –January XX: GPSC representative approval of memorandum to BOT –February 10: Submit memorandum to Deans, Student Affairs and Student Health Services –February 24: BOT Meeting with presentation to Student Affairs Subcommittee

7. Four Principle Issues We need feedback from Representatives on these issues to help shape our statement of values on health insurance: 1) Optimizing Utilization 2) Family Subsidy 3) Participation 4) Institutional Support

8. Issue 1: Optimizing Utilization Question: what are most effective and tolerable methods for controlling rate of health insurance premium increases through utilization and keep our campus’s healthiest members in the Duke plan? Increase brand name drug co-pays? Reduce drug formulary? Add emergency room visit co-pay? Increase annual deductible? Cover all family utilization at specific clinic? Closely case-manage historically high users?

9. Issue 2: Family Subsidy SingleFamily Utilization$757$4773 Premium$1063$2282 Subsidy62% * Assuming that claims equal 80% of "true" premium, this means that the premium for families should have been $5966.25 for families in 2003-2004, but their premium was only $2282, meaning that 62% of their premium was paid by single students

10. Issue 2: Family Subsidy Question: What is the appropriate level of subsidy of Family Plan premiums by Single Person Plan premiums? Who should pay subsidy? 59% (current)? 25%? 0%? Single students? University?

11. Issue 3: Participation Question: Should we mandate participation in the student health insurance plan by all students? Some students? Address underinsurance issue? Lower premiums by improving average utilization per student? Affect autonomy?

12. Issue 4: Institutional Support Question: How can Duke move toward covering health insurance costs for all students? Endowed funds? Other models? Self-insurance? What should be covered first, e.g., doctoral students, family subsidy?

13. Feedback Email comments? Send out email reminder? Online survey? By what date? (See Timeline) –Need time for them to collect opinions

14. Contact Information For additional comments or questions, please contact: Justin Klein –(617) 529-1243 –Justin.klein@duke.eduJustin.klein@duke.edu Megan McCrudden –(XXX) XXX-XXXX –Megan.mccrudden@duke.eduMegan.mccrudden@duke.edu Eric Vance –(XXX) XXX-XXXX –Eric.vance@duke.eduEric.vance@duke.edu