Student insurance plan requires balance

By Michael Winters     4/16/09 7:00pm

Rice University has invested considerable effort in recent years to improve health insurance coverage for students. Success can be measured in many ways, improved care and lower costs among them. By those measures, we have been successful. Negotiating a student insurance plan is a complex task with many different considerations: How much overall cost should students bear? What essential services do they need? What kind of provider network best serves students? Is the insurance company stable? Should all students on the plan pay a higher cost for a few students who may become ill, or should overall costs be kept to a minimum with students who become ill paying for a higher percentage of their care?

The procedure for negotiating a plan at Rice begins with a health insurance committee composed of graduate students - no undergraduate students have applied to be on the committee in the past few years - physicians and administrators. This committee met several times this year. The insurance committee reviewed the current plan and considered changes to increase value or provide needed services to students. We created a list of modifications to propose to the insurance provider. The provider then enumerated the cost of each modification. As Rice's health plan administrator, I made the final choice of plan options, advised by other staff members who have expertise in health insurance.

Rice has chosen Aetna as its plan provider because Aetna has one of the largest local and national networks of health care providers. We feel it is important for students to have as much variety in choosing providers as possible. By working with Aetna over several years we have been able to address problems in communication and service delivery.

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Rice consults with a broker to review the student health plan, but not to negotiate it. Retaining a broker can increase the premium cost for the insurance plan and not necessarily produce the best outcome. By negotiating directly with Aetna we were able to enhance the plan benefits at a total cost of $1,486 per student for the 2009-'10 policy year. That's an annual savings of $246 compared with the previous policy year and a one-third reduction from the $2,193 premium in 2007-'08. The 2009-'10 price is the lowest cost for a Rice health insurance plan since 2003-'04.

So what will the plan for next year look like? In addition to the substantial savings in premium costs, some important enhancements have been added, including adjustments for prescription coverage, mental health care and routine office visits for children through 12 months. Specifically, the annual prescription deductible of $100 is eliminated, the annual prescription policy year maximum is increased from $1,500 to $3,000 and prescriptions can be filled up to a 60-day supply with one co-pay, which will reduce from 12 to six the number of co-pays for a medication that has to be filled on a monthly basis. The annual mental health outpatient maximum of $50 per visit and the annual mental health outpatient maximum of $500 have been eliminated, and the plan will allow 60 visits per policy year for a substantial improvement in mental health benefits.

In addition, Rice will now subsidize health insurance for doctoral students who subscribe to the plan in their first eight years of study, as opposed to six before.

While it is impossible to completely satisfy every need, I believe that the lower cost and increased benefits in this plan are a major improvement for our students. Over time we will continue to explore additional options, but we will always try our best to keep the plan affordable to all and provide the appropriate level of insurance for our population as a whole. In addition, we will continue to engage students as we explore choices for health care insurance as one of many ways that Rice is seeking to improve the overall educational and living environment for our hardworking and talented students.

As in the past, we will work with students to resolve problems or complaints about the insurance provider. Students can contact me at winters@rice.edu if they feel they have not gotten fair treatment or an appropriate response from Aetna, or need additional information about the Rice plan.

Michael Winters, Acting Assistant Dean of Student Affairs for Health Programs.

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