Background on SHIP for SHAC Meeting

Waiver, Appeals, and 2015-2016 Plan

Changes
October 21, 2015

Agenda
SHIP 101
SHIP Governance
SHIP Waiver

Fall 2014 what happened, what did we do about it

Spring 2015 experience
Fall 2015
New Appeal Form for Spring 2016

2015-2016 SHIP Changes

Benefit and premium changes
Discontinuation of dependent and continuation plans

ALL students have access to

University Health Services

~60% of students
have SHIP

Plan Carriers
Medical and mental health plan through
Aetna Student Health (ASH)
Dental plan through MetLife
Vision plan through Vision Service Plan (VSP)

Student Health

Insurance at UC Berkeley
All UC Students are:
Required to have major medical health insurance
Automatically enrolled in SHIP when registered
(current SHIP coverage August 15-August 14)
Able to enroll in SHIP any time within the semester if their
current coverage is lost (no prorated rate)
Able to maintain dual coverage
Able to waive out of the plan through an online waiver

ACA Essential Health Benefits:

preventive and wellness services and chronic disease
management
mental health and substance abuse disorder services,
including behavioral health treatment
rehabilitative and habilitative services and devices
ambulatory patient services
emergency services
hospitalization
maternity and newborn care
prescription drugs
Berkeley SHIP
laboratory services

already provided
all of these benefits plus
includes dental and vision

SHIP BENEFIT HIGHLIGHTS

Preventative

100% covered (you pay $0)

Primary Care

$15 co-pay

Specialists

$15 co-pay

Urgent Care

$30 at UHS; $50 outside UHS

Counseling

Outside UHS $15 co-pay (first five visits free at UHS for all students)

Emergency Room

$100 co-pay

Hospitalization

90% co-insurance (you pay 10%)

Labs/tests/x-rays

90% co-insurance (you pay 10%)

Prescription drugs $5 generic, $25 brand name

Dental

2 free cleanings/exams per year; 80% co-insurance minor dental, 70%

co-insurance coverage major dental (up to $1000/year)

Vision

$10 eye exam, $25 co-pay frames & lenses, or contact lenses
(up to $120/year)

Deductible

$300 for some services outside of Tang

Based on in-network providers

Glossary
Premium The amount you pay to be enrolled in insurance plan
EXAMPLE: Berkeley SHIPs undergrad premium is $1290/semester

Co-insurance The percentage of the health care costs you have to pay.
EXAMPLE: For some services, Berkeley SHIP pays 90%, and you pay 10%

Deductible The amount of medical costs you have to pay before your
insurance kicks in per year.
EXAMPLE: Berkeley SHIP has a $300 annual deductible for some services outside of Tang

Co-pay An upfront cost you pay when you have an office visit; Not counted as
part of deductibles.
EXAMPLE: Primary Care visits at Tang are $15

SHIP Governance
ADVISORY ROLES

Campus
stakeholders
provide input
on RFP and
plan selection
UHS initiates
SHIP renewal
process and
Broker seeks
carrier bids

Campus
Leads and
UHS advise
on final
decision

SHIAC &
student
leadership
provide
feedback on
RFP and plan

ASUC

GA

CSF

CFO in
consultation
with campus
administration
makes final
decision

UHS
manages
daily
operations for
SHIP

SHAC

Note: Waiver criteria set system-wide.

Fall SHIP Aug 15-Jan 14

Spring SHIP Jan 15-Aug 14

SHIP COVERAGE PERIOD

SHIP WAIVER PERIOD

Spring Waiver deadline Jan 10

(alt. coverage must begin by Jan 15)

Fall (Annual) Waiver deadline July 15

(alt. coverage must begin by Aug 15)
July

Aug

Sept

Oct

Nov

Dec

Fall waiver covers full academic year; if you waive

for fall, you wont need to waive again in spring.

Jan

Feb

Mar

Apr

May

June

July

Late waiver deadline $50 late fee:

Fall Sept.15, Spring Feb. 5

SHIP WAIVER APPEAL

A waiver appeal form can be filed within 10 business days of waiver denial.
(Those on financial aid will be prioritized, a new feature added by
recommendation ASUC SAO)
SHIP will notify of waiver appeal decision within 30 days.

SHIP Waiver Communication

Three emails: April, July, September
Postcard to home address in June
Cal Parents
CalSO/MyBerkeleyApp
eBill notification, Cal Student Central
Be Well @ Cal Social Media (Facebook, Twitter,
monthly buzz eNews)
Tang website homepage
ASUC Student Advocate Office (SAO) communications

SHIP Waiver Fall 2014

As a result of massive changes in the health insurance
marketplace, our student leaders along with other UC
student leaders and Student Affairs Vice Chancellors
advocated for strengthening the waiver criteria to
block out some plans:
These are plans that have low up front costs (so they
seem affordable), but if you actually use them, would
cost hundreds, if not thousands, of dollars out of pocket
first posing a barrier to care and a financial burden.

SHIP Waiver Fall 2014

Before waiving, our website instructs users to
complete a worksheet (PDF) with all the questions in
the waiver.
This mirrors the online application flow and questions to
get them ready to fill out the actual waiver.

As long as the information entered matches the

criteria, you get an instant waiver confirmation.
About 10k families successfully waived.

SHIP Waiver Fall 2014

Problem assessment
Over the summer, we noticed significant
numbers of students were failing the online
waiver process (AKA being denied a waiver).

Normally we process 1500 waiver appeals,

fall 2014 we had 7500 (400% increase).
Most problems were just user error, not reading
instruction or having all the information before
submitting form.

Why did this happen?

More than 75% of fall waiver appeals were approved,
indicating user error attributed to most all of the
confusion.
Students admitted they didnt complete worksheet or
bother to get the actual information just guessed.
Social media (Reddit, Facebook groups, Daily Cal)
posted waiver hacks that spread misinformation.
Families were confused about some terminology
easily obtainable from your insurance company but
still can be confusing.

Impact
The mass volume of appeals impacted the
timeliness of when we could process appeals.
Parents and students calling about status of appeal
created massive customer communication backlog
UHS responded with:
dedicating more staff and management time
work with key stakeholder to keep them
informed and make tweaks as possible

What did we do about it?

In August, UCOP lightened the requirements for
two criteria (pharmacy deductible and out of
pocket maximums that didnt factor in Health
Savings Accounts) systemwide
Sent email to ALL students about the new waiver
requirements
Streamlined the waiver form and provided more
info to make it simpler
New! SHIP Waiver Cheat Sheet (ASUC SAO)

In partnership
with ASUC SAO

SHIP Waiver Fall 2015

This Fall, about 17,200 waivers submitted
Of these about 3,900 denied
About 3100 appeals, of which 2,700 passed appeal
Over 15,900 successfully waived out
Word of caution: We audit 25% of waived accounts and
those who didnt complete correctly will be charged for
SHIP. Additional auditing and possible student conduct
action for those who post cheats

New for waivers for 2016

SHIP Office has developed a new online appeals form
SAO is testing the development site now
Will pilot for Spring 2016 Waiver season
Will replace the need to mail, fax, drop off or email
appeals form
Should make appeals easier and more efficient
Systemwide changes to waiver criteria to further
simplify or clarify criteria to take effect Fall 2016.

SHIP Changes for 2015-2016

Premium increased:
Undergrad premium = $1,290/semester
Graduate premium = $1,877/semester
Deductible increased from $200 to $300
Discontinuation of voluntary plans:
Continuation plan
Dependent plan

Discontinuation of Dependent Plan

Why the University made the decision:
ACA required parity rates (or equal rates for family
members)
Meaning student price would go up to reduce
dependent price
Less than 1% of students on SHIP had voluntary
dependents on the plan
Informed that 50 other campuses made similar
decision, including UCSB

Resources Voluntary Members

Free insurance helpline to assist in finding new plans

Information sessions for dependents
Transition Assistance Fund for Dependents
Individualized help at the SHIP Office

Lessons Learned
Need for more transparency about SHIP Renewal
process and decision making
More avenues for student and campus stakeholder
feedback
Will look at options to offer dependent coverage
More clarity about timeline

http://uhs.berkeley.edu/ship
ship@uhs.berkeley.edu
(510) 642-5700

Thank you!