During the summer, the administration announced that it has revamped the health insurance coverage that the University offers in order to comply with the Patient Protection and Affordable Care Act (PPACA).
Also known as the Healthcare Act, the Affordable Care Act, and Obamacare, PPACA was signed in 2010 by President Barack Obama and went into effect in March 2012, when the Department of Health and Human Services released its final ruling. As of Aug. 1, 2012, although Gallagher Koster remains the outside provider for Wesleyan’s university-sponsored plan, the health insurance preferred provider’s name has changed from First Health to UnitedHealthcare Options PPO.
Students who choose to opt in to the student health insurance plan will now receive comprehensive preventive care benefits. These benefits do not involve cost-sharing at any in-network providers, including the Davison Health Center on campus, and they include one-hundred-percent coverage of regular physicals, gynecological exams, STI testing, and immunizations. If the provider of one of those services is in network, rather than paying for a certain percentage of the cost of that service and requiring the patient to either pay the rest out of pocket or to pay an annual deductible relating to the service, the insurance company for the student health insurance plan will cover all of the costs associated with that service.
In order to offset the costs of providing more comprehensive coverage, students and their families are now paying a larger annual payment, totaling $1,132 for an individual student, in order to enroll in the health insurance plan, compared to the $860 annual fee charged for an individual student’s enrollment during the 2011-2012 academic year.
In addition to general coverage changes, there will also be expanded coverage of women’s services, in accordance with the Women’s Health Initiative, which amended the Affordable Care Act’s guidelines regarding women’s services.
“The goal of these new guidelines is to ensure a comprehensive set of preventive services for women, including preventive screenings, well-woman visits, support for breastfeeding equipment, contraception, and domestic violence screening,” Gallagher Koster wrote in a brochure.
According to information from Gallagher Koster’s 2012-2013 explanation of benefits, oral contraceptives are now covered at one hundred percent under the University’s plan, with no copayment. Previously, oral contraceptives were provided at a discounted rate, but not fully covered under the plan.
The Affordable Care Act also provides for several other important changes in service, in particular regarding healthcare coverage for students. Under the Act’s provisions, for example, student health insurance plans must provide specific coverage for essential benefits up to a minimum of $100,000 per policy year, voiding any internal limits on these benefits. Essential benefits include ambulatory patient services, emergency services, hospitalization, prescription drugs, maternity and newborn care, mental health and substance abuse disorder services, diagnostic tests, and wellness and preventive care.
Previously, many student health insurance plans, including the University’s, offered only partial coverage of many of these services, with far lower maximum benefits or limits on total annual coverage. Under the University’s previous student health insurance plan, for example, lab work and diagnostic tests were often not covered or only partially covered, as were ambulance services, prescription drugs, and certain mental health and substance abuse-related services. Prescriptions are now covered up to the policy maximum, and charges related to other essential benefits are significantly reduced.
Another key provision of the Affordable Care Act includes coverage of treatment for pre-existing conditions, previously excluded by many insurance companies that want to avoid paying more money on a long-term basis for patient treatment. The University’s health plan accordingly now includes immediate coverage of pre-existing conditions as of the effective date of the plan.
Although this year’s student health insurance plan, like all previous plans, does not include dental insurance, an optional dental plan is being offered to students through UnitedHealthcare. However, the annual payment for dental coverage under the plan is $347, and the maximum policy limit is only $500 per person per plan year. Basic dental services other than restorations are not covered; neither are major dental services such as crowns, inlays, onlays, dentures and other prosthetics, and fixed partial dentures, or bridges.
The deadline to enroll in the dental plan is Sept. 26, 2012. The enrollment deadline for the student health insurance plan was Aug. 15, 2012.