Student Insurance

What is the program’s mission statement or statement of purpose? Why does the program exist?

To enhance the educational process by removing health-related barriers, with an affordable plan of insurance that meets the student’s needs.

How does the program mission align with the university mission?

Student Insurance provides a plan of insurance that allows students to seek medical treatment for health-related barriers that could interfere with their educational goals. The plan minimizes the financial burden, allowing students to remain healthy to pursue an education.

The Student Insurance Staff provide education to students, teaching them how an insurance plan works, and how to understand their benefits. Education is also provided on the privacy and security of protected health information and financial resources for medical treatment.

The Student Insurance Office also provides an integrative learning opportunity for students. Student employees have the opportunity to learn about enrollment and cancellation of a policy, benefits, privacy and security of protected health information, and the operation of administering an insurance plan.

Whom does the program serve?

The program serves students of Eastern Illinois University. Students enrolled in nine or more on-campus hours are automatically assessed the Student Insurance fee as a part of their tuition and fees statement. Students with part-time hours may also enroll in the plan.

The program serves several groups with specific insurance needs including graduate students, international students, athletes, students in the Lakeview College of Nursing program, prospective students and alum’s.

The program serves students that encounter injuries and illnesses as well as those that may have chronic health issues.

What are the services provided? How do these services align with the university mission and program mission?

Student Insurance administers two self-insured, self-funded plans of insurance. The Student Insurance plan provides an accident and illness plan of insurance to all eligible students. The Student Insurance Plan does not have a network; it provides worldwide coverage, 24/7 and is available all year. The plan provides coverage for students, regardless of where they may study or travel.

The Varsity Insurance plan provides a plan of medical coverage for injury to students that officially participate in Intercollegiate Sports sanctioned by the NCAA. The Varsity Insurance plan allows athletes to participate in intercollegiate sports without a financial risk.

The Student Insurance Office manages eligibility, enrollment, cancellation, re-enrollment, and reinstatement for the plans in addition to processing and adjudicating all claims for both plans. We also develop the brochures, webpages, and all materials. Student employees are provided an integrative learning experience allowing them to experience and work in all aspects of an insurance office.

The Student Insurance Office provides orientation sessions for several student groups, and is present at freshman debut, informational fairs and open houses. The Student Insurance Office also visits classes to discuss insurance coverage, provide an overview of benefits, and assist in educating students about insurance. Students benefit from the opportunity to learn life skills that will be needed beyond their time at Eastern Illinois University.

The Student Insurance Office plays a very important customer service role. We are the liaison between the student (patient) and the medical provider. We educate students on their role in receiving medical treatment and provide information and assistance to medical providers and other payers. The Student Insurance staff also works closely with parents to ensure medical treatment is paid for promptly and accurately.

Describe the program’s origins (e.g. year established, purpose, expectations).

The Student Insurance Plan has been available for many years; however, reliable information prior to 1968 was not available. In 1968, the Student Insurance Plan was a plan designed to supplement and compliment the services normally available to students through the University Health Service in order that they may be protected at times when the service did not apply and for accidents and illnesses which it did not cover. The plan was available for spouses and dependents and was considered a major medical plan. The maximum per injury or illness under the plan was $5,000. This plan was underwritten by the American United Life Insurance Company. All students that were assessed the full registration fee by the University were eligible for coverage and required to pay the Student Insurance fee unless they could produce evidence of equal or better coverage.

The maximum benefit increased to $10,000 per injury or illness in 1969. In 1976, Blue Cross Blue Shield became the underwriter. The plan remained major medical coverage for accident and sickness and offered coverage for spouses and dependents. In 1978, the eligibility criteria was updated to specify that all students registering for a minimum of twelve hours were considered full time and eligible for coverage. The fee continued to be required for all full time students. The underwriter changed to Guarantee Trust Life Insurance Company in 1982. Blue Cross Blue Shield returned as the underwriter in 1985. The plan description was changed to “A Plan of Medical Coverage for Accident and Sickness” in 1987, removing the “Major Medical” distinction.

In 1998, the Student Insurance Plan became a self-funded, self-insured plan. The eligibility requirement dropped to nine on-campus hours. Spouse and dependent coverage were discontinued; the maximum benefit remained at $10,000 per injury or illness. The maximum benefit was increased to $15,000 per injury or illness in 2004 and to $25,000 in 2010.

How has the unit changed or adapted over time?

The Student Insurance Office is a part of the Student Affairs Division. The office was included in Financial Aid, under the direction of the Financial Aid Director until July 1, 2012. At this time, Financial Aid moved to Academic Fairs, Student Insurance became an independent department reporting to the Director of Health Service.

The Student Insurance Plan was established as a supplement to services available at the Health Service. The plan transitioned as a secondary payer, continuing to supplement these services while providing coverage for a multitude of services not available at the Health Service. In recent years, the economy has played a major role in the transition of the Student Insurance Plan as the primary insurance company for many students. Some no longer have coverage through a parent due to loss of employment or the cost of dependent coverage. Others are too old to remain on a parents plan. High deductible health plans are leaving students with large out-of-pocket expenses. Managed health plans and network plans may provide little or no coverage when students are not in the plan network area. The Student Insurance plan provides a great financial benefit for these students, reducing or eliminating their out-of-pocket expense for medical treatment.

As a self-funded, self-insured plan, the program took on the added responsibility of developing the plan document, brochure, marketing materials, as well as the risk. We have negotiated discount agreements with local providers based on sound relationships that have been in place for several years.

Healthcare and insurance have seen a multitude of changes since the program’s inception. A few of the challenges include the Health Information Portability and Accountability Act (HIPAA), electronic claims processing, and Healthcare Reform. During the next year, a new coding classification system (ICD-10) will be implemented.

Medicine and technology have also played a role in changes. New procedures, conditions, and technologies are discovered each year. In the future, the plan will need to continue to adapt to remain beneficial to the student.

If needed, provide supplemental comments to help the reader understand the program’s history and relevance to university mission.

Provide data, if available, on the numbers of students, faculty, staff, or others served by the program during the past four years. If no data are available, please estimate the numbers served annually.

Plan Enrollment Data

Students provide the greatest internal demand to the Student Insurance Office. Many will encounter their first experiences with medical providers and insurance while they are enrolled at EIU. The Student Insurance staff educates them on proper filing procedures, the benefits of both primary and secondary insurance coverage, coordination of benefits with other health or auto insurance coverage, and financial responsibilities associated with medical expenses. We act as the liaison between the student and the provider, offering assistance to both parties to assure claims are processed timely and accurately. Many of our students do not have any other health insurance coverage. They are appreciative that Eastern offers a plan specifically designed for students.

The Student Insurance Department responds to internal demands from New Student Programs, Admissions, Health Service, Athletics, Housing, Graduate School, International Students and Scholars, and Lakeview College of Nursing. The demands from these areas range from participation in informational fairs; providing orientation programming, advising program benefits; providing coverage for students that are required to report to campus before the beginning of a term and more.

Specialized orientation sessions are designed and conducted for International Students and Scholars and Lakeview College of Nursing. These sessions are designed for the specific student groups. The orientation addresses benefits, how to use the plan, an overview of the combined benefit of Health Service and Student Insurance, distribution of brochures and insurance cards, and FAQ sessions.

Athletics depends on Student Insurance to verify the primary insurance information for athletes. This information helps trainers identify athletes without active primary insurance, policies that do not provide coverage for local providers, preauthorization/predetermination requirements, precertification requirements, and high deductible health plans. This information helps mitigate loss to the Varsity Insurance Plan.

The Health Service, Counseling Center, Student Standards, and Admissions place demands on Student Insurance during the late withdrawal/suspension process. Student Insurance must determine if the Student Insurance Fee must remain on a student’s account depending on the date of the withdrawal and/or the receipt of medical claims prior to a withdrawal. Student Insurance notifies Student Accounts when to add or remove the Student Insurance Fee.

Student Insurance and Student Accounts work closely together to manually bill select student groups for insurance. Student Insurance communicates coverage dates, lock-in dates, and provides support for questions that students and parents have about the fee and their account.

Information Security and the University HIPAA Officer place demands for training as well as protecting the privacy and security of protected health information (PHI) and electronic protected health information (ePHI).

The Student Insurance Office participates in the annual Health Fair sponsored by the Health Service. This event allows us to interact with students and members of the community. Information on eligibility, enrollment, and benefits is provided.

Student Insurance is a resource for sexual assault victims. We provide information on payment for medical treatment specific to these victims.

Does the program offer any co-curricular opportunities for students (e.g., internships, RSO support, service-learning activities)? Please describe.

The Student Insurance provides an integrative learning experience for student employees. This opportunity provides them experience working for an insurance company. Through their training, students develop an understanding of HIPAA, and privacy and security requirements placed on health information professionals. They work with various aspects of the eligibility and enrollment procedures as well as the claims process. They work with specialized software, technologies and equipment that provides an excellent experience which is useful for future career opportunities.

Does the program contribute to the delivery of academic programs (e.g., providing professional expertise, serving as adjunct faculty)? Please describe.

Several academic programs reach out to Student Insurance with requests due to specific program requirements and internships. Student Insurance works with the programs to provide programming, hold informational sessions, and distribute brochures and insurance cards. Some of the programs reaching out for assistance include Rec Administration, Communication Disorders and Sciences, Health Studies, International Students and Scholars and the Graduate School.

If needed, provide supplemental comments to help the reader understand the internal demand for the program. Note any clarifications or special circumstances (e.g., curriculum changes made by another program) that should be considered when reviewing the above data.

Is the program accredited or approved by a recognized external agency or otherwise certified to meet established professional standards? Provide an executive summary of and link to the program’s most recent accreditation or certification report, if available.

N/A

Is the program required to meet any regulatory or legal requirements? Is the program subject to any special auditing requirements?

The Student Insurance Office is a HIPAA Covered Entity; the only covered entity at Eastern Illinois University. As a covered entity we are required to follow the HIPAA Privacy and Security Rules and the HITECT Act.

HIPAA Privacy Rule and the HIPAA Security Rule. The Privacy Rule, or Standards for Privacy of Individually Identifiable Health Information, establishes national standards for the protection of certain health information. The Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) establish a national set of security standards for protecting certain health information that is held or transferred in electronic form. The Security Rule operationalizes the protections contained in the Privacy Rule by addressing the technical and non-technical safeguards that organizations called “covered entities” must put in place to secure individuals’ “electronic protected health information” (e-PHI).

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, promotes the adoption and meaningful use of health information technology.  HITECH addresses the privacy and security concerns associated with the electronic transmission of health information.

Annual risk assessments are conducted to assess compliance with HIPAA Security and Privacy Rules. The assessments look for administrative, physical, and technical risks. The Student Insurance Office location and the inability to accept claims electronically have been identified as potential risks.

The Student Insurance Office must also respond to subrogation inquiries from the Illinois Department of Public Aid. These inquiries assist the agency in making payment determination.

What are the most important outreach or public service activities supported by the program?

Student Insurance provides outreach during Debut, Open House, Transfer Orientation, Lakeview College of Nursing Orientation, and International Students and Scholars Orientation. This outreach effort provides opportunities for students and parents to learn how to use the Student Insurance Plan and the benefits offered by the plan. Many students do not realize the benefits of a secondary insurance when they have other insurance. After discussing the plan benefits, parents and students usually decide to remain in the Student Insurance Plan due to the financial benefits and additional coverage provided by the plan.

Student Insurance participates in the Health Fair, offering students and the community an opportunity to learn more about the Plan.

How do the local community and the region benefit from the program?

The local medical providers and Student Insurance benefit from an excellent working relationship. We are able to provide prompt payment for services and in return have been able to negotiate discount agreements that benefit the Plan and our students. We recently re-negotiated the agreement with Sarah Bush Lincoln Health Center to include an increase from 10% to 18% for students with the Student Insurance Plan as their primary payer. An additional 10% discount of the balance was added for students with other insurance.

For Varsity Insurance, we were able to increase the discount to 30% for students who did not have any other insurance, and added the 10% discount of the balance when the student has other insurance.

Lakeland Radiology provides a 10% discount for students when Student Insurance is primary. They recently increased their Varsity Discount to 30% when Varsity Insurance is primary and then added a 10% discount when Varsity Insurance pays secondary.

The local providers know the challenges of working with college students. They depend on Student Insurance to help educate the students and guide them through their initial encounters. They know we make multiple attempts to reach students so claims can be processed, resulting in fewer claims that are sent to collections or are written off. Sarah Bush Lincoln Health Center has incorporated the Student Insurance Claim Form into their registration process. This helps the Student Insurance Office collect information at the point of treatment and helps the hospital with reimbursement.

We have long standing relationships with several other local providers due to the level of customer service provided.

If needed, provide supplemental comments or data sources to help the reader understand the external demand for the program.

Student Insurance supports alumni of the university. Many graduates or former students will contact the office for verification of insurance during their time at EIU.

We respond to requests from attorneys and other payers to complete a claims investigation and to coordinate benefits when multiple payers are involved.

We respond, on a daily basis, to providers across the country. Providers contact us for billing information, eligibility, coverage details, and claims status. We are able to provide prompt, accurate information.

What are the two or three more important measureable outcomes tracked to assess program quality? Does the program conduct an outcomes assessment, and if so, what has been the impact?

The percentage of students enrolled in the plan continues to increase each year. This also demonstrates the number of students waiving each semester continues to decrease.

The amount Student Insurance pays as the Primary Payer as compared to the Secondary Payer continues to grow. This demonstrates the dependence students have on the Student Insurance Plan.

*Note: Claims for 12/13 can be submitted through August 13, 2014. Claims are just starting to come in for Fall 2013.

The number of claims that hit the maximum benefit also continues to increase each year.

*Note: Claims for 12/13 can be submitted through August 13, 2014.

Finally, we monitor the amounts we are billed, percentage paid by a primary insurance, percentage paid by Student Insurance, percentage of discount for Student Insurance, and percentage of member responsibility. This information helps us understand the demand for the insurance, the rate billed amounts increase, and how our benefits and discounts affect our students.

*Note: Claims for 12/13 can be submitted through August 13, 2014.

What are the two or three most effective best practices that the program has implemented? What benefits have been gained from implementing these best practices?

The Student Insurance Office has implemented several best practices to help protect student’s privacy, ensure they know their eligibility and/or coverage status, and verify the accuracy of the images we retain.

Some students invoke their privacy rights with the university. These students are highlighted with a special “Confidential” status in Banner, allowing anyone that accesses information on the student to know of the student’s request. Student Insurance uses a claims processing software that is not part of Banner. A special report was developed that provides a list of all students with a confidential status. The status comment is added to the student’s demographic information in the claims software, alerting insurance staff about the student’s request. This process allows Student Insurance to comply with the student’s privacy request. We do not provide information to medical providers or any other inquiries for these students, without the student’s specific permission.

The Student Insurance Office is currently located in an open are of the Financial Aid Office. This is a high traffic area. Black privacy screens are used on the monitors of insurance staff to hide all student protected health information. The screens prevent anyone from seeing student information unless they are directly in front of the screen. This best practice protects the students privacy and helps reduce the risk of a breech.

Beginning in Fall 2013, a new “My Health” tab was added to Banner self-serve PAWS. The tab allows students to access their Student Insurance eligibility and coverage information for the semester, any time of the day, any day of the week. Students and local medical providers have been educated on this new feature. There is also a link that allows them to print their personalized insurance card in the My Health tab.

The Student Insurance Office receives hundreds of documents weekly. The documents are scanned and indexed for storage and easy retrieval. Accuracy in the indexing is essential. A quality audit process was implemented to verify the accuracy of each scanned batch. The audit process was based on national standards according to sample size. Batches that exceed 1% of errors are inspected 100% to ensure documents are legible and accurately indexed.

What external recognitions (e.g., awards, accommodations, professional certifications, references in trade publications) have the program and its staff received in the past three years?

The Student Insurance Office has been recognized with a Certificate of Appreciation by New Student Programs for participation in Freshman and Transfer Debut Orientation. The Health Service also provided a certificate of recognition for participation in the Health Fair.

Sarah Bush Lincoln Health Center and Charleston Ambulance have recognized the office for excellent customer service

Professional Certifications: Angela Campbell, Registered Health Information Administrator (RHIA), American Health Information Management Association (AHIMA) 2011, AHIMA-Approved ICD-10-CM/PCS Trainer – 2011, 2012, 2013

Is the program active with any regional, national, or international professional organizations?

The Student Insurance Office holds membership with the American College Health Association (ACHA), Mid-America College Health Association (MACHA), and the Illinois Consortium of Student Health Programs (ICSHP).

We have are active on the ACHC Health Information Management/HIPAA Coalition and the Student Health Insurance Benefit Plan Coalition.

Angela Campbell - member American Health Information Management Association (AHIMA), Illinois Health Information Management Association (ILHIMA). Committee assignments for ILHIMA are ICD-10 Subcommittee, Communication Committee.

Cheryl Hochstetler - member American Health Information Management Association (AHIMA), Illinois Health Information Management Association (ILHIMA).

Note any presentations, publications, or offices held in the last three years.

Angela Campbell - Presenter “ICD-10: What You Need to Know”, American College Health Association Annual Meeting, Chicago, IL 2012

Presenter “ICD-10: What is it? How do I Prepare for it?” American College Health Association Annual Meeting, Boston MA, 2013

Secretary, HIM/HIPAA Coalition, American College Health Association 2012, 2013

If needed, provide supplemental comments or data sources to help the reader understand the quality of program outcomes.

Note any special benefits (e.g., personnel support, equipment, permanent improvements) that the program has received in the past three years from its grants and other sponsored programs.

N/A

How does the program benefit from donor gifts (e.g., scholarships, endowed chairs)? Does donor support provide a significant percentage of the program’s overall funding?

N/A

List two or three key relationships that the program maintains with external constituencies (e.g., community colleges, other universities, government bodies). How do these relationships advance the university mission or otherwise benefit the university?

The Student Insurance Office is a member of the Illinois Consortium of Student Health Programs. We participate in meetings twice a year and have ongoing conversations with Student Insurance Offices at the other Illinois public institutions. As a benefit, we receive regular updates on trends, concerns, and legislative issues specific to student health and student health insurance programs. We collaborate and share ideas, expertise, policies, procedures, and best practices. We learn from each other’s experiences and gain an understanding for each programs design. What we learn from each other serves as a basis in making decisions that benefit our programs.

We have an institutional membership in the American College Health Association (ACHA). This membership affords us the opportunity to work with professionals from across the country that deal with the same issues and concerns. The association provides information or recommends resources for our needs. This membership also provides us with opportunities to participate in committee work. We are members of the Student Health Insurance Plan Coalition and Health Information/HIPAA Coalition.

The relationships with our local providers, specifically Sarah Bush Lincoln Health Center and Lakeland Radiology provide financial benefits to the Student Insurance Plan and the students we cover. We have been able to renegotiate and increase our discount agreements, helping make medical treatment more affordable for students and reducing payout from the Student Insurance Plan. The excellent customer service provided by the Student Insurance Office was the basis for renegotiation. We have developed processes to provide eligibility and benefit information, allowing claims to be submitted timely to the correct primary payer. Sarah Bush Lincoln provides claim forms to students during their registration process which helps expedite this process.

We also work closely with the Financial Assistance Program at Sarah Bush Lincoln Health Center, ensuring Student Insurance makes payment when students are covered. We refer students to this program for remaining financial obligations, which is a significant benefit for students. They are more likely to seek medical treatment and remain healthy so they can pursue their education. These efforts have reduced the number of students referred to collections and reduced the number of claims denied for lack of information from the students.

When students utilized hospital services other than Sarah Bush Lincoln Health Center and their only health insurance coverage is Student Insurance, we routinely contact the hospital to request a discount on behalf of the student. This often results in a lower out-of-pocket expense to the student and a smaller payment from the Student Insurance Plan. We have also been able to obtain discounts for athletes.

If needed, provide supplemental comments to help the reader understand the resources generated by the program. Note any clarifications or special circumstances (e.g., revenue pass-throughs) that should be considered when reviewing the above data.

The Student Insurance Fee is the sole funding source for the Student Insurance Office. Students are billed the fee based on their eligibility status. Students enrolled in nine or more on-campus hours are automatically assessed the Student Insurance Fee. Students with coverage equal to or better than the Student Insurance Plan may waive the Student Insurance Fee. Students enrolled in six, seven, or eight on-campus hours may purchase the Student Insurance Plan. There has not been an increase to the fee since Fall 2007.

Student Insurance Fee – Fall 2007 to present

Provide an executive summary of and link to any metrics or benchmarks that the program tracks to measure productivity.

The Student Insurance Office tracks the number of claims and cases processed each plan year. Claims are individual bills from medical providers for injury or illness cases. Each case may have multiple claims. The number of claims and cases processed depends on the number of cases filed with Student Insurance. We do not have a benchmark to compare data since no other institutions process claims in the same manner. We do not use a repricer, receive electronic claims, or have an underwriter. All claims are manually entered and processed in house. Each year the number of cases and claims processed increased while the staffing resources have remained the same.

*Note: Claims for 12/13 can be submitted through August 13, 2014. Cases will be established as needed for any 12/13 claims that are filed.

What initiatives has the program implemented to enhance staff productivity (e.g., access to training, workflow improvements)? Briefly describe the costs and benefits of these initiatives.

Student Insurance staff participates in professional development workshops and webinars to update skills and remain current on industry news and standards. These training opportunities are provided at no cost to the department.

Student Insurance staff members share resources stored on a secure server, allowing all staff access to documents. We are able to review information simultaneously, which has eliminated the need for paper in many instances.

We moved to an online coding resource that is regularly updated, allowing staff to research codes with a few key strokes rather than using coding books for three separate classification systems which are revised quarterly. There was a net increase of less than $100 annually for this change.

During Spring 2012, an additional monitor was purchased for each staff member. The additional monitor allows staff to work in two programs simultaneously. We are able to work in the claims software, keeping it visible at all times while viewing scanned images, researching codes, and verifying information in Banner. During the Summer and Fall 2012, Student Insurance acquired several pieces of equipment including a network scanner, fax machine, and shredder. The purchases were due to the separation of Student Insurance from Financial Aid. They were one-time expenses that added much efficiency to the department. The purchases also reduced several risks identified in earlier risk assessments. The unit is now self-contained. All work is conducted within the area. The fax machine doubles as a copier for most of the unit’s needs.

Student Insurance and Athletics worked together on a project which improved customer service to medical providers and increased productivity. We were provided access to Nextt, the injury management system used by Athletics. As a result, we are able to confirm injuries with providers during telephone conversations, even before a claim form is received. We are also able to identify ongoing treatment efforts and are alerted of upcoming medical appointments scheduled for our athletes.

If needed, provide supplemental comments to help the reader understand the productivity of the program. Note any clarifications or special circumstances (e.g., accreditation requirements, curricular changes, program restructuring) that should be considered when reviewing the above data.

If needed, provide supplemental comments to help the reader understand the costs associated with the program. Note any clarifications or special circumstances (e.g., expenditures made centrally or externally, expenditures made on behalf of other units) that should be considered when reviewing the above data.

On July 1, 2012, Student Insurance became an independent department. Several small pieces of equipment including a shredder, fax, and network scanner had to be acquired. Supplies were no longer purchased by or partially funded by Financial Aid. Cost savings were also realized through salary expenses.

Student Insurance has been a 3-person department with one student worker for more than ten years. Due to the retirement of the previous insurance manager in 2012 and the uncertainty created by Healthcare Reform, an extra-help employee was brought in to complete the Student Insurance staffing needs until a consultation could be completed and decisions made about the future insurance plan needs.

How does the program seek to distinguish itself from similar programs at other institutions?

The Student Insurance Office administers two self-funded, self-insured insurance plans; the Student Insurance Plan and the Varsity Insurance Plan. We are the only state institution that offers a self-insured, self-funded insurance plan for students and athletes. The Office operates as an insurance company. 100% of the efforts from writing the plan to paying the claims are performed by the Student Insurance Office. We oversee brochure development, enrollment and eligibility, claims processing, and payment of claims. Students have come to expect the highest level of customer service from our department. We assist them with each step of the process from providing enrollment instructions, verifying their eligibility, explaining benefits, assisting with the completion of documentation, reviewing their Explanation of Benefits (EOB), providing resources for financial assistance, and acting as a liaison with their medical providers, insurance company, and parents. When students or parents have questions about coverage or payment of a claim, they come to or contact the Student Insurance Office for the answers. There is no middleman. We are a one-stop shop for their insurance needs which saves the students time and reduces the cost of the program.

Students learn life skills while working with the Student Insurance staff. They learn how to read insurance documents, become familiar with insurance terminology, learn about financial resources for medical services, and understand the process of submitting insurance claims. This prepares our students to enter the work force better informed about insurance options.

Students at Eastern Illinois University have the opportunity to speak directly with the individuals that will work with their medical providers and adjudicate their claims. They are not calling a “giant” insurance company where they never speak to the same individual twice. Students develop relationships with the staff that last throughout their college years. The Student Insurance staff goes the extra mile to work with a student’s primary insurance carrier and the medical provider, ensuring the highest level of reimbursement on the student’s behalf.

The Student Insurance Office verifies the insurance coverage of all students that apply to waive the Student Insurance Fee. We often find coverage has changed or terminated, leaving the student with reduced benefits or no coverage at all. Students are notified of the discrepancies in coverage and re-enrolled in the Student Insurance Plan. Identifying this information for the student ensures students are adequately covered while in college. It also prevents students from financial hardships caused by lack of health insurance. The staff also verifies insurance coverage for athletes. This verification allows the athletic training staff to coordinate medical treatment for athletes with medical providers covered by the athlete’s primary insurance. The Student Insurance Office works closely with Athletic Training to ensure services are preauthorized or pre-certified.

The Student Insurance staff has membership and is active in the American Health Information Management Association. The Student Insurance Office is prepared for the transition to ICD-10 with an AHIMA Approved ICD-10-CM/PCS Trainer on staff. Eastern Illinois University is the only state school in Illinois that has presented at the American College Health Association National Conference on a health information/insurance topic.

Note any unique and/or essential contributions that the program makes to the university.

The Student Insurance Office provides an integrative learning experience for student employees. This opportunity provides them experience working for an insurance company. They are provided training and develop an understanding of HIPAA, and privacy and security requirements that are placed on health information professionals. They work with various aspects of the eligibility and enrollment procedures as well as the claims process. They work with specialized software, technologies and equipment that will provide experience useful in future career opportunities.

Several academic programs reach out to Student Insurance with requests due to specific program requirements and internships. Student Insurance works with these programs to provide programming, hold informational sessions, and distribute brochures and insurance cards. Some programs that have requested assistance include Rec Administration, Communication Disorders and Sciences, Health Studies, International Students and Scholars and the Graduate School.

Student Insurance plays an important role in Open House, Freshman and Transfer Debut, providing Student Insurance information to new students and their parents. This interaction provides the parents and students a sense of security, knowing and understanding their students are covered for illnesses and injuries while at school.

Student Insurance is a resource for sexual assault victims. We provide information on payment for medical treatment specific to these victims.

The Student Insurance Office participates in the annual Health Fair sponsored by the Health Service. This event allows us to interact with students and members of the community. Information on enrollment, eligibility, and benefits is provided.

Provide any program-specific metrics that help to document program contributions or program quality. Examples of some commonly used program-specific metrics may be found here.

The percentage of students enrolled in the plan continues to increase each year. This also demonstrates the number of students waiving each semester continues to decrease.

The amount Student Insurance pays as the Primary Payer as compared to the Secondary Payer continues to grow. This demonstrates the dependence students have on the Student Insurance Plan.

*Note: Claims for 12/13 can be submitted through August 13, 2014.

Number of Cases/Claims Processed - Claims are individual bills from medical providers; cases are an injury or illness. Each case may have multiple claims. The number of claims and cases processed depends on the number of cases filed with Student Insurance. We do not have a benchmark to compare this data since no institutions process claims in the same manner. We do not use a repricer, receive electronic claims, or have an underwriter. All claims are manually entered and processed in house. Each year the number of cases and claims processed increased while the staffing resources have remained the same.

*Note: Claims for 12/13 can be submitted through August 13, 2014.

Average Monthly Contacts – The Student Insurance Office tracks the number of contacts on a monthly basis. The following data demonstrates the current monthly averages.

If needed, provide supplemental comments to help the reader understand the program impact on the university mission.

Provide a link to or listing of the program’s goals and/or strategic plan.

The primary goal of the Student Insurance Office is to provide a plan of insurance that meets the student’s needs. The current plan is an accident and illness plan that is currently in the process of review and revision. A consultant is reviewing the current plan and will provide recommendations for moving forward with plan updates and changes. Our goal is to provide a plan that is compliant with the Patient Protection Affordable Care Act (PPACA).

The Student Insurance Office provides several outreach programs for new students; however, there is a need for programming for continuing students and those who have not participated in the orientation sessions. We would like to develop a program for continuing students and specific student groups to further explain the Student Insurance Plan, the benefits and how to use them as a primary or secondary payer. Students and parents are very aware of changes due to the Patient Protection Affordable Care Act (PPACA). We need to address questions and concerns they have and provide explanation of how the PPACA affects them.

The Student Insurance Office provides a level of customer service unlike most other programs since we are also the insurance company. Students build a relationship with the staff, are educated about insurance, and know they have a liaison to work on their behalf. A very important goal is to maintain the level of customer service and the opportunities the program provides. Some schools have outsourced their insurance product, leaving students to figure everything out for themselves. Students end up with financial burdens because they do not understand the insurance claim process and do not have a gatekeeper overseeing their claim status. Our staff work with providers to make sure students are not sent to collections when the students have insurance coverage and we are diligent in our efforts to work with the students ensuring all required documentation is submitted. We also negotiate discounts on behalf of the students, saving them additional expenses.

Students prefer to communicate electronically when possible. Health information cannot be transmitted via email unless it is secure. The Student Insurance Office has partnered with Health Service to work towards the ability to communicate with students via secure messaging. It is our goal to implement the use of secure messaging, allowing us to communicate in a secure format, much quicker than traditional postal mail.

Currently, the Student Insurance forms may not be submitted electronically. We are pursuing opportunities to transition our paper documents to electronic format.

What role will the program have in the implementation of the university’s strategic plan (provide link to strategic plan)?

The Student Insurance Office plays an important role in the Academic Excellence plank of the Strategic Plan. We work diligently to remove health-related barriers to the student’s educational goals. Students must have health insurance to cover conditions that may interfere with their educational pursuits so they may remain healthy during and after their college years. Providing a plan of insurance, educating them about their insurance benefits and how to use them, affords students the opportunity to pursue or continue their education.

The Student Insurance Office plays an important role in the Campus and Community Life plank. We have developed and continue to enhance the relationship with the local medical providers. This relationship has led to increased discounts for the Student Insurance and Varsity Insurance Plans.

The Financial Sustainability plank of the Strategic Plan focuses on maintaining enrollment. The Student Insurance Office assists in reaching this goal by providing an insurance plan for students. Students do consider their medical coverage when making choices about which school they will attend. We continue to see an increasing number of students coming to school without any other insurance. They depend on the Student Insurance Plan for all of their health needs that cannot be addressed by Health Service. Students who have other health insurance coverage are experiencing higher deductibles and out-of-pocket expenses. The secondary coverage Student Insurance provides for these students helps keep their healthcare affordable, particularly when their primary coverage is based on a network that is not in the Eastern Illinois University area.

In the next two or three years, what best practices, improvements in operations, or other opportunities to advance the university’s mission are likely to be implemented?

It is likely the Student Insurance Plan will move towards a plan that complies with the Patient Protection Affordable Care Act (PPACA) in the near future. Coverage for services at the Health Service may also be included in the Plan.

Students regularly request that the Student Insurance Plan be expanded. They would like to see dental, vision, spouse, and dependent coverage added to the plan.

The Student Insurance Plan will make improvements in the ability to accept claims electronically from medical providers to ensure we are HIPAA compliant.

If needed, provide supplemental comments to help the reader understand future opportunities for the program.

The Student Insurance Plan has not seen an increase in cost for seven years. Benefits have changed minimally since the plan became self-funded in 1998. The plan moved from a major medical insurance plan that provided spouse and dependent coverage to a plan for illness and injury for the student only. We are excited about the possibility of an improved PPACA compliant plan and enthusiastic about the opportunity for changes to the plan, which will further meet the needs of our students.